Procalcitonin to Guide Initiation and Duration of Antibiotic Treatment in Acute Respiratory Infections: An Individual Patient Data Meta-Analysis

This individual patient data meta-analysis of clinical trials investigating procalcitonin algorithms for antibiotic decision making found no increased risk of death or setting-specific treatment failure but did find significantly lower antibiotic exposure across different acute respiratory infections and clinical setting

A large annotated medical image dataset for the development and evaluation of segmentation algorithms

Semantic segmentation of medical images aims to associate a pixel with a label in a medical image without human initialization. The success of semantic segmentation algorithms is contingent on the availability of high-quality imaging data with corresponding labels provided by experts. We sought to create a large collection of annotated medical image datasets of various clinically relevant anatomies available under open source license to facilitate the development of semantic segmentation algorithms. Such a resource would allow: 1) objective assessment of general-purpose segmentation methods through comprehensive benchmarking and 2) open and free access to medical image data for any researcher interested in the problem domain. Through a multi-institutional effort, we generated a large, curated dataset representative of several highly variable segmentation tasks that was used in a crowd-sourced challenge - the Medical Segmentation Decathlon held during the 2018 Medical Image Computing and Computer Aided Interventions Conference in Granada, Spain. Here, we describe these ten labeled image datasets so that these data may be effectively reused by the research community

The Medical Segmentation Decathlon

International challenges have become the de facto standard for comparative assessment of image analysis algorithms. Although segmentation is the most widely investigated medical image processing task, the various challenges have been organized to focus only on specific clinical tasks. We organized the Medical Segmentation Decathlon (MSD)—a biomedical image analysis challenge, in which algorithms compete in a multitude of both tasks and modalities to investigate the hypothesis that a method capable of performing well on multiple tasks will generalize well to a previously unseen task and potentially outperform a custom-designed solution. MSD results confirmed this hypothesis, moreover, MSD winner continued generalizing well to a wide range of other clinical problems for the next two years. Three main conclusions can be drawn from this study: (1) state-of-the-art image segmentation algorithms generalize well when retrained on unseen tasks; (2) consistent algorithmic performance across multiple tasks is a strong surrogate of algorithmic generalizability; (3) the training of accurate AI segmentation models is now commoditized to scientists that are not versed in AI model training

Economic evaluation of procalcitonin-guided antibiotic therapy in acute respiratory infections: a US health system perspective

Background: Whether or not antibiotic stewardship protocols based on procalcitonin levels results in cost savings remains unclear. Herein, our objective was to assess the economic impact of adopting procalcitonin testing among patients with suspected acute respiratory tract infection (ARI) from the perspective of a typical US integrated delivery network (IDN) with a 1,000,000 member catchment area or enrollment. Methods: To conduct an economic evaluation of procalcitonin testing versus usual care we built a cost-impact model based on patient-level meta-analysis data of randomized trials. The meta-analytic data was adapted to the US setting by applying the meta-analytic results to US lengths of stay, costs, and practice patterns. We estimated the annual ARI visit rate for the one million member cohort, by setting (inpatient, ICU, outpatient) and ARI diagnosis. Results: In the inpatient setting, the costs of procalcitonin-guided compared to usual care for the one million member cohort was $2,083,545, compared to$2,780,322, resulting in net savings of nearly $700,000 to the IDN for 2014. In the ICU and outpatient settings, savings were$73,326 and $5,329,824, respectively, summing up to overall net savings of$6,099,927 for the cohort. Results were robust for all ARI diagnoses. For the whole US insured population, procalcitonin-guided care would result in $1.6 billion in savings annually. Conclusions: Our results show substantial savings associated with procalcitonin protocols of ARI across common US treatment settings mainly by direct reduction in unnecessary antibiotic utilization. These results are robust to changes in key parameters, and the savings can be achieved without any negative impact on treatment outcomes

Evaluating conditions and impact of intermodal traffic management involving airports and railways

Developing a transport system meeting the requirement of seamless door-to-door travel as envisioned by the report Flightpath 2050 necessitates a conjunction of different modes in the form of physical connections, encompassing management structures, and appropriate business models. We employ our simulation environment comprising of microscopic simulation and associated management tools to evaluate the possibility of not only exchanging information, but also adjusting operational parameters on the basis of the overall situation. The questions are what information exchange is needed, how large is the operational impact, and how can the anticipated success of an overall traffic management be assessed. Reliable data are crucial for management and evaluation. We show that on the one hand, management capabilities can be enhanced by determining the overall state of an airport and on the other hand by considering the so-called passenger trajectory. The state can be retrieved from Key Performance Indicators and Key Control Parameters which represent adjustable parameters. The passenger trajectory consists of pairs of points in space and time, where the passenger passes a certain milestone of the journey. This data can be used to compute the remaining time to the airport or even to a specific gate determining whether a passenger can be at the gate in time. If a critical mass is reached, intermodal operations can be adjusted. Our management system based on the microscopic simulation includes a connection to railway and aircraft movement management together with a forecast to estimate the propagation of the state of the airport. The evaluation capability of our system is demonstrated by a scenario consisting of a delay of a train leading to passengers not being able to reach their flight. Based on the data, the system - including microscopic simulation and management structure - provides the sensitivity of Key Performance Indicators such as boarding score on the change of delay profiles. This provides a measure for the feasibility of an action based on its extent focusing on cross-modal operation changes

Video tracking of swimming rodents on a reflective water surface

Animal models are an essential testbed for new devices on their path from the bench to the patient. Potential impairments by brain stimulation are often investigated in water mazes to study spatial memory and learning. Video camera based tracking systems exist to quantify rodent behaviour, but reflections of ambient lighting on the water surface and artefacts due to the waves caused by the swimming animal cause errors. This often requires tweaking of algorithms and parameters, or even potentially modifying the lab setup. In the following, we provide a simple solution to alleviate these problem using a combination of region based tracking and independent multimodal background subtraction (IMBS) without hav ing to tweak a plethora of parameters

Towards Seamless Source Mobility in SSM - Design and Evaluation of the Tree Morphing Protocol

Multimedia networking in the near future is expected to be dominated by group applications such as IPTV, MMORPGs, and video conferencing. Hand in hand with new service offers, the deployment of multicast at the network layer started to disseminate. Currently infotainment is gradually expanding into the mobile world, but a standard design of mobile multicast is still awaited. In this paper we present a design and discuss an extensive evaluation of the Tree Morphing Protocol that performs an adaptive tree management to support seamless handovers for mobile SSM sources. Based on a full protocol implementation on a network simulator platform, we extensively explore the protocol performance. By employing artificial networks to cover fundamental topological constellations, as well as real-world network topologies, we analyze the handover behavior conceptually and in realistic scenarios. Strengths and weaknesses of the routing scheme are identified, leading to a discussion on future improvements