Diagnostic performance on briefly presented digital pathology images

Background: Identifying new and more robust assessments of proficiency/expertise (finding new "biomarkers of expertise") in histopathology is desirable for many reasons. Advances in digital pathology permit new and innovative tests such as flash viewing tests and eye tracking and slide navigation analyses that would not be possible with a traditional microscope. The main purpose of this study was to examine the usefulness of time-restricted testing of expertise in histopathology using digital images.
Methods: 19 novices (undergraduate medical students), 18 intermediates (trainees), and 19 experts (consultants) were invited to give their opinion on 20 general histopathology cases after 1 s and 10 s viewing times. Differences in performance between groups were measured and the internal reliability of the test was calculated.
Results: There were highly significant differences in performance between the groups using the Fisher's least significant difference method for multiple comparisons. Differences between groups were consistently greater in the 10-s than the 1-s test. The Kuder-Richardson 20 internal reliability coefficients were very high for both tests: 0.905 for the 1-s test and 0.926 for the 10-s test. Consultants had levels of diagnostic accuracy of 72% at 1 s and 83% at 10 s.
Conclusions: Time-restricted tests using digital images have the potential to be extremely reliable tests of diagnostic proficiency in histopathology. A 10-s viewing test may be more reliable than a 1-s test. Over-reliance on "at a glance" diagnoses in histopathology is a potential source of medical error due to over-confidence bias and premature closure.

A Review of Indirect Bridge Monitoring Using Passing Vehicles

Indirect bridge monitoring methods, using the responses measured from vehicles passing over bridges, are under development for about a decade. A major advantage of these methods is that they use sensors mounted on the vehicle, no sensors or data acquisition system needs to be installed on the bridge. Most of the proposed methods are based on the identification of dynamic characteristics of the bridge from responses measured on the vehicle, such as natural frequency, mode shapes, and damping. In addition, some of the methods seek to directly detect bridge damage based on the interaction between the vehicle and bridge. This paper presents a critical review of indirect methods for bridge monitoring and provides discussion and recommendations on the challenges to be overcome for successful implementation in practice.

Identification of Road Irregularities via Vehicle Accelerations

A periodic monitoring of the pavement condition facilitates a cost-effective distribution of the resources available for maintenance of the road infrastructure network. The task can be accurately carried out using profilometers, but such an approach is generally expensive. This paper presents a method to collect information on the road profile via accelerometers mounted in a fleet of non-specialist vehicles, such as police cars, that are in use for other purposes. It proposes an optimisation algorithm, based on Cross Entropy theory, to predict road irregularities. The Cross Entropy algorithm estimates the height of the road irregularities from vehicle accelerations at each point in time. To test the algorithm, the crossing of a half-car roll model is simulated over a range of road profiles to obtain accelerations of the vehicle sprung and unsprung masses. Then, the simulated vehicle accelerations are used as input in an iterative procedure that searches for the best solution to the inverse problem of finding road irregularities. In each iteration, a sample of road profiles is generated and an objective function defined as the sum of squares of differences between the ‘measured’ and predicted accelerations is minimized until convergence is reached. The reconstructed profile is classified according to ISO and IRI recommendations and compared to its original class. Results demonstrate that the approach is feasible and that a good estimate of the short-wavelength features of the road profile can be detected, despite the variability between the vehicles used to collect the data.

Detection of Bridge Dynamic Parameters using an Instrumented Vehicle

Highway structures such as bridges are subject to continuous degradation primarily due to ageing and environmental factors. A rational transport policy requires the monitoring of this transport infrastructure to provide adequate maintenance and guarantee the required levels of transport service and safety. In Europe, this is now a legal requirement - a European Directive requires all member states of the European Union to implement a Bridge Management System. However, the process is expensive, requiring the installation of sensing equipment and data acquisition electronics on the bridge. This paper investigates the use of an instrumented vehicle fitted with accelerometers on its axles to monitor the dynamic behaviour of bridges as an indicator of its structural condition. This approach eliminates the need for any on-site installation of measurement equipment. A simplified half-car vehicle-bridge interaction model is used in theoretical simulations to test the possibility of extracting the dynamic parameters of the bridge from the spectra of the vehicle accelerations. The effect of vehicle speed, vehicle mass and bridge span length on the detection of the bridge dynamic parameters are investigated. The algorithm is highly sensitive to the condition of the road profile and simulations are carried out for both smooth and rough profiles

Monitoring Bridge Dynamic Behaviour using an Instrumented Two Axle Vehicle

Highway structures such as bridges are subject to continuous degradation primarily due to ageing, loading and environmental factors. A rational transport policy must monitor and provide adequate maintenance to this infrastructure to guarantee the required levels of transport service and safety. Increasingly in recent years, bridges are being instrumented and monitored on an ongoing basis due to the implementation of Bridge Management Systems. This is very effective and provides a high level of protection to the public and early warning if the bridge becomes unsafe. However, the process can be expensive and time consuming, requiring the installation of sensors and data acquisition electronics on the bridge. This paper investigates the use of an instrumented 2-axle vehicle fitted with accelerometers to monitor the dynamic behaviour of a bridge network in a simple and cost-effective manner. A simplified half car-beam interaction model is used to simulate the passage of a vehicle over a bridge. This investigation involves the frequency domain analysis of the axle accelerations as the vehicle crosses the bridge. The spectrum of the acceleration record contains noise, vehicle, bridge and road frequency components. Therefore, the bridge dynamic behaviour is monitored in simulations for both smooth and rough road surfaces. The vehicle mass and axle spacing are varied in simulations along with bridge structural damping in order to analyse the sensitivity of the vehicle accelerations to a change in bridge properties. These vehicle accelerations can be obtained for different periods of time and serve as a useful tool to monitor the variation of bridge frequency and damping with time.

Experimental Investigation of the Detection of Bridge Dynamic Parameters using a Moving Vehicle

This paper investigates the feasibility of using an instrumented vehicle to detect bridge dynamic parameters, such as natural frequency and structural damping, in a scaled laboratory experiment. In the experiment, a scaled vehicle model crosses a steel girder which has been adopted as the bridge model. The bridge model also includes a scaled road surface profile. The effects of varying vehicle model mass and speed are investigated. The damping of the girder is also varied. The bridge frequency and changes in damping are detected in the vehicle acceleration response in the presence of a rough road surface profile.

Experimental investigation of drive-by bridge inspection

This study presents a vibration-based health monitoring of short span bridges by
an inspection vehicle. How to screen health condition of short span bridges in terms of the
drive-by bridge inspection is described. Feasibility of the drive-by bridge inspection is
investigated through a scaled laboratory moving vehicle experiment. The feasibility of using an
instrumented vehicle to detect the natural frequency and changes in structural damping of a
model bridge is observed. Observations also demonstrate possibility of diagnosis of bridges by
comparing patterns of identified dynamic parameters of bridges through a periodical
monitoring. It is confirmed that the method for damage identification under a moving vehicle
identifies the damage location and severity well.

Using Instrumented Vehicles To Detect Damage in Bridges

Bridge structures are subject to continuous degradation due to the environment, ageing and excess loading. Monitoring of bridges is a key part of any maintenance strategy as it can give early warning if a bridge is becoming unsafe. This paper will theoretically assess the ability of a vehicle fitted with accelerometers on its axles to detect changes in damping of bridges, which may be the result of damage. Two vehicle models are used in this investigation. The first is a two degree-of-freedom quarter-car and the second is a four degree-of-freedom halfcar. The bridge is modelled as a simply supported beam and the interaction between the vehicle and the bridge is a coupled dynamic interaction algorithm. Both smooth and rough road profiles are used in the simulation and results indicate that changes in bridge damping can be detected by the vehicle models for a range of vehicle velocities and bridge spans.

Using Instrumented Vehicles to Detect Damage in Bridges

This paper describes a ‘drive-by’ method of bridge inspection using an instrumented vehicle. Accelerometers on the vehicle are proposed as a means of detecting damage on the bridge in the time it takes for the vehicle to cross the bridge at full highway speed. For a perfectly smooth road profile, the method is shown to be feasible. Changes in bridge damping, which is an indicator of damage, are clearly visible in the acceleration signal of a quarter-car vehicle on a smooth road surface modelled using MatLab. When road profile is considered, the influence of changes in bridge damping on the vehicle acceleration signal is much less clear. However, when a half-car model is used on a road with a rough profile, it is again possible to detect changes in bridge damping, provided the vehicle has two identical axles.

Dynamic axle force and road profile identification using a moving vehicle

The axle forces applied by a vehicle through its wheels are a critical part of the interaction between vehicles, pavements and bridges. Therefore, the minimisation of these forces is important in order to promote long pavement life spans and ensure that bridge loads are small. Moreover, as the road surface roughness affects the vehicle dynamic forces, the monitoring of pavements for highways and bridges is an important task. This paper presents a novel algorithm to identify these dynamic interaction forces which involves direct instrumentation of a vehicle with accelerometers. The ability of this approach to predict the pavement roughness is also presented. Moving force identification theory is applied to a vehicle model in theoretical simulations in order to obtain the interaction forces and pavement roughness from the measured accelerations. The method is tested for a range of bridge spans in simulations and the influence of road roughness level on the accuracy of the results is investigated. Finally, the challenge for the real-world problem is addressed in a laboratory experiment.

Effectiveness of a biomarker-based exclusion of ventilator-acquired pneumonia to reduce antibiotic use: protocol for a randomised controlled trial (VAPrapid-2):Study protocol for a randomised controlled trial

Background Ventilator-acquired pneumonia (VAP) is a common reason for antimicrobial therapy in the intensive care unit (ICU). Biomarker-based diagnostics could improve antimicrobial stewardship through rapid exclusion of VAP. Bronchoalveloar lavage (BAL) fluid biomarkers have previously been shown to allow the exclusion of VAP with high confidence. Methods/Design This is a prospective, multi-centre, randomised, controlled trial to determine whether a rapid biomarker-based exclusion of VAP results in fewer antibiotics and improved antimicrobial management. Patients with clinically suspected VAP undergo BAL, and VAP is confirmed by growth of a potential pathogen at > 104 colony-forming units per millilitre (CFU/ml). Patients are randomised 1:1, to either a ‘biomarker-guided recommendation on antibiotics’ in which BAL fluid is tested for IL-1β and IL-8 in addition to routine microbiology testing, or to ‘routine use of antibiotics’ in which BAL undergoes routine microbiology testing only. Clinical teams are blinded to intervention until 6 hours after randomisation, when biomarker results are reported to the clinician. The primary outcome is a change in the frequency distribution of antibiotic-free days (AFD) in the 7 days following BAL. Secondary outcome measures include antibiotic use at 14 and 28 days; ventilator-free days; 28-day mortality and ICU mortality; sequential organ failure assessment (SOFA) at days 3, 7 and 14; duration of stay in critical care and the hospital; antibiotic-associated infections; and antibiotic-resistant pathogen cultures up to hospital discharge, death or 56 days. A healthcare-resource-utilisation analysis will be calculated from the duration of critical care and hospital stay. In addition, safety data will be collected with respect to performing BAL. A sample size of 210 will be required to detect a clinically significant shift in the distribution of AFD towards more patients having fewer antibiotics and therefore more AFD. Discussion This trial will test whether a rapid biomarker-based exclusion of VAP results in rapid discontinuation of antibiotics and therefore improves antibiotic management in patients with suspected VAP.

Meta-analysis of Positive and Negative Symptoms Reveals Schizophrenia Modifier Genes

BACKGROUND: Evidence suggests that genetic factors may influence both schizophrenia (Scz) and its clinical presentation. In recent years, genome-wide association studies (GWAS) have demonstrated considerable success in identifying risk loci. Detection of "modifier loci" has the potential to further elucidate underlying disease processes.

METHODS: We performed GWAS of empirically derived positive and negative symptom scales in Irish cases from multiply affected pedigrees and a larger, independent case-control sample, subsequently combining these into a large Irish meta-analysis. In addition to single-SNP associations, we considered gene-based and pathway analyses to better capture convergent genetic effects, and to facilitate biological interpretation of these findings. Replication and testing of aggregate genetic effects was conducted using an independent European-American sample.

RESULTS: Though no single marker met the genome-wide significance threshold, genes and ontologies/pathways were significantly associated with negative and positive symptoms; notably, NKAIN2 and NRG1, respectively. We observed limited overlap in ontologies/pathways associated with different symptom profiles, with immune-related categories over-represented for negative symptoms, and addiction-related categories for positive symptoms. Replication analyses suggested that genes associated with clinical presentation are generalizable to non-Irish samples.

CONCLUSIONS: These findings strongly support the hypothesis that modifier loci contribute to the etiology of distinct Scz symptom profiles. The finding that previously implicated "risk loci" actually influence particular symptom dimensions has the potential to better delineate the roles of these genes in Scz etiology. Furthermore, the over-representation of distinct gene ontologies/pathways across symptom profiles suggests that the clinical heterogeneity of Scz is due in part to complex and diverse genetic factors.