In vivo bioimpedance changes during haemorrhagic and ischaemic stroke in rats: Towards 3D stroke imaging using electrical impedance tomography

Electrical impedance tomography (EIT) could be used as a portable non-invasive means to image the development of ischaemic stroke or haemorrhage. The purpose of this study was to examine if this was possible using time difference imaging, in the anesthetised rat using 40 spring-loaded scalp electrodes with applied constant currents of 50-150 μA at 2 kHz. Impedance changes in the largest 10% of electrode combinations were -12.8% ± 12.0% over the first 10 min for haemorrhage and +46.1% ± 37.2% over one hour for ischaemic stroke (mean ± SD, n = 7 in each group). The volume of the pathologies, assessed by tissue section and histology post-mortem, was 12.6 μl ± 17.6 μl and 12.6 μl ± 17.6 μl for haemorrhage and ischaemia respectively. In time difference EIT images, there was a correspondence with the pathology in 3/7 cases of haemorrhage and none of the ischaemic strokes. Although the net impedance changes were physiologically reasonable and consistent with expectations from the literature, it was disappointing that it was not possible to obtain reliable EIT images. The reason for this are not clear, but probably include confounding effects of secondary ischaemia for haemorrhage and tissue and cerebrospinal fluid shifts for the stroke model. With this method, it does not appear that EIT with scalp electrodes is yet ready for clinical use

A pragmatic cluster randomized controlled trial of an educational intervention for GPs in the assessment and management of depression

Background. General practitioners (GPs) can be provided with effective training in the skills to manage depression. However, it remains uncertain whether such training achieves health gain for their patients. Method. The study aimed to measure the health gain from training GPs in skills for the assessment and management of depression. The study design was a cluster randomized controlled trial. GP participants were assessed for recognition of psychological disorders, attitudes to depression, prescribing patterns and experience of psychiatry and communication skills training. They were then randomized to receive training at baseline or the end of the study. Patients selected by GPs were assessed at baseline, 3 and 12 months. The primary outcome was depression status, measured by HAM-D. Secondary outcomes were psychiatric symptoms (GHQ-12) quality of life (SF-36), satisfaction with consultations, and health service use and costs. Results. Thirty-eight GPs were recruited and 36 (95%) completed the study. They selected 318 patients, of whom 189 (59%) were successfully recruited. At 3 months there were no significant differences between intervention and control patients on HAM-D, GHQ-12 or SF-36. At 12 months there was a positive training effect in two domains of the SF-36, but no differences in HAM-D, GHQ-12 or health care costs. Patients reported trained GPs as somewhat better at listening and understanding but not in the other aspects of satisfaction. Conclusions. Although training programmes may improve GPs' skills in managing depression, this does not appear to translate into health gain for depressed patients or the health service

EIT-MESHER – Segmented FEM Mesh Generation and Refinement

EIT-MESHER (https://github.com/EIT-team/Mesher) is C++ software, based on the CGAL library, which generates high quality Finite Element Model tetrahedral meshes from binary masks of 3D volume segmentations. Originally developed for biomedical applications in Electrical Impedance Tomography (EIT) to address the need for custom, non-linear refinement in certain areas (e.g. around electrodes), EIT-MESHER can also be used in other fields where custom FEM refinement is required, such as Diffuse Optical Tomography (DOT)

Phase division multiplexed EIT for enhanced temporal resolution

Objective: The most commonly used EIT paradigm (time division multiplexing) limits the temporal resolution of impedance images due to the need to switch between injection electrodes. Advances have previously been made using frequency division multiplexing (FDM) to increase temporal resolution, but in cases where a fixed range of frequencies is available, such as imaging fast neural activity, an upper limit is placed on the total number of simultaneous injections. The use of phase division multiplexing (PDM) where multiple out of phase signals can be injected at each frequency is investigated to increase temporal resolution. Approach: TDM, FDM and PDM were compared in head tank experiments, to compare transfer impedance measurements and spatial resolution between the three techniques. A resistor phantom paradigm was established to investigate the imaging of one-off impedance changes, of magnitude 1% and with durations as low as 500 µs (similar to those seen in nerve bundles), using both PDM and TDM approaches. Main results: In head tank experiments, a strong correlation (r  >  0.85 and p  <  0.001) was present between the three sets of measured transfer impedances, and no statistically significant difference was found in reconstructed image quality. PDM was able to image impedance changes down to 500 µs in the phantom experiments, while the minimum duration imaged using TDM was 5 ms. Significance: PDM offers a possible solution to the imaging of fast moving impedance changes (such as in nerves), where the use of triggering or coherent averaging is not possible. The temporal resolution presents an order of magnitude improvement of the TDM approach, and the approach addresses the limited spatial resolution of FDM by increasing the number of simultaneous EIT injections

Communication in cross-cultural consultations in primary care in Europe: the case for improvement. The rationale for the RESTORE FP 7 project

The purpose of this paper is to substantiate the importance of research about barriers and levers to the implementation of supports for cross-cultural communication in primary care settings in Europe. After an overview of migrant health issues, with the focus on communication in cross-cultural consultations in primary care and the importance of language barriers, we highlight the fact that there are serious problems in routine practice that persist over time and across different European settings. Language and cultural barriers hamper communication in consultations between doctors and migrants, with a range of negative effects including poorer compliance and a greater propensity to access emergency services. It is well established that there is a need for skilled interpreters and for professionals who are culturally competent to address this problem. A range of professional guidelines and training initiatives exist that support the communication in cross-cultural consultations in primary care. However, these are commonly not implemented in daily practice. It is as yet unknown why professionals do not accept or implement these guidelines and interventions, or under what circumstances they would do so. A new study involving six European countries, RESTORE (REsearch into implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings), aims to address these gaps in knowledge. It uses a unique combination of a contemporary social theory, normalisation process theory (NPT) and participatory learning and action (PLA) research. This should enhance understanding of the levers and barriers to implementation, as well as providing stakeholders, with the opportunity to generate creative solutions to problems experienced with the implementation of such interventions

Comparison of total variation algorithms for electrical impedance tomography

The applications of total variation (TV) algorithms for electrical impedance tomography (EIT) have been investigated. The use of the TV regularisation technique helps to preserve discontinuities in reconstruction, such as the boundaries of perturbations and sharp changes in conductivity, which are unintentionally smoothed by traditional l2 norm regularisation. However, the non-differentiability of TV regularisation has led to the use of different algorithms. Recent advances in TV algorithms such as the primal dual interior point method (PDIPM), the linearised alternating direction method of multipliers (LADMM) and the spilt Bregman (SB) method have all been demonstrated successful EIT applications, but no direct comparison of the techniques has been made. Their noise performance, spatial resolution and convergence rate applied to time difference EIT were studied in simulations on 2D cylindrical meshes with different noise levels, 2D cylindrical tank and 3D anatomically head-shaped phantoms containing vegetable material with complex conductivity. LADMM had the fastest calculation speed but worst resolution due to the exclusion of the second-derivative; PDIPM reconstructed the sharpest change in conductivity but with lower contrast than SB; SB had a faster convergence rate than PDIPM and the lowest image errors

Multifrequency electrical impedance tomography with total variation regularization

Multifrequency electrical impedance tomography (MFEIT) reconstructs the distribution of conductivity by exploiting the dependence of tissue conductivity on frequency. MFEIT can be performed on a single instance of data, making it promising for applications such as stroke and cancer imaging, where it is not possible to obtain a baseline measurement of healthy tissue. A nonlinear MFEIT algorithm able to reconstruct the volume fraction distribution of tissue rather than conductivities has been developed previously. For each volume, the fraction of a certain tissue should be either 1 or 0; this implies that the sharp changes of the fractions, representing the boundaries of tissue, contain all the relevant information. However, these boundaries are blurred by traditional regularization methods using l2 norm. The total variation (TV) regularization can overcome this problem, but it is difficult to solve due to its non-differentiability. Because the fraction must be between 0 and 1, this imposes a constraint on the MFEIT method based on the fraction model. Therefore, a constrained optimization method capable of dealing with non-differentiable problems is required. Based on the primal and dual interior point method, we propose a new constrained TV regularized method to solve the fraction reconstruction problem. The noise performance of the new MFEIT method is analysed using simulations on a 2D cylindrical mesh. Convergence performance is also analysed through experiments using a cylindrical tank. Finally, simulations on an anatomically realistic head-shaped mesh are demonstrated. The proposed MFEIT method with TV regularization shows higher spatial resolution, particularly at the edges of the perturbation, and stronger noise robustness, and its image noise and shape error are 20% to 30% lower than the traditional fraction method

On the spectral density from instantons in quenched QCD

We investigate the contribution of instantons to the eigenvalue spectrum of the Dirac operator in quenched QCD. The instanton configurations that we use have been derived, elsewhere, from cooled SU(3) lattice gauge fields and, for comparison, we also analyse a random `gas' of instantons. Using a set of simplifying approximations, we find a non-zero chiral condensate. However we also find that the spectral density diverges for small eigenvalues, so that the chiral condensate, at zero quark mass, diverges in quenched QCD. The degree of divergence decreases with the instanton density, so that it is negligible for the smallest number of cooling sweeps but becomes substantial for larger number of cools. We show that the spectral density scales, that finite volume corrections are small and we see evidence for the screening of topological charges. However we also find that the spectral density and chiral condensate vary rapidly with the number of cooling sweeps -- unlike, for example, the topological susceptibility. Whether the problem lies with the cooling or with the identification of the topological charges is an open question. This problem needs to be resolved before one can determine how important is the divergence we have found for quenched QCD.Comment: 33 pages, 16 figures (RevTex), substantial revisions; to appear in Phys.Rev.