Introduction to Library Trends 21 (1) Summer 1972: Trends of Archival and Reference Collections of Recorded Sound

published or submitted for publicatio

Automatic 3D Multi-modal Ultrasound Segmentation of Human Placenta using Fusion Strategies and Deep Learning

Purpose: Ultrasound is the most commonly used medical imaging modality for diagnosis and screening in clinical practice. Due to its safety profile, noninvasive nature and portability, ultrasound is the primary imaging modality for fetal assessment in pregnancy. Current ultrasound processing methods are either manual or semi-automatic and are therefore laborious, time-consuming and prone to errors, and automation would go a long way in addressing these challenges. Automated identification of placental changes at earlier gestation could facilitate potential therapies for conditions such as fetal growth restriction and pre-eclampsia that are currently detected only at late gestational age, potentially preventing perinatal morbidity and mortality. Methods: We propose an automatic three-dimensional multi-modal (B-mode and power Doppler) ultrasound segmentation of the human placenta using deep learning combined with different fusion strategies.We collected data containing Bmode and power Doppler ultrasound scans for 400 studies. Results: We evaluated different fusion strategies and state-of-the-art image segmentation networks for placenta segmentation based on standard overlap- and boundary-based metrics. We found that multimodal information in the form of B-mode and power Doppler scans outperform any single modality. Furthermore, we found that B-mode and power Doppler input scans fused at the data level provide the best results with a mean Dice Similarity Coefficient (DSC) of 0.849. Conclusion: We conclude that the multi-modal approach of combining B-mode and power Doppler scans is effective in segmenting the placenta from 3D ultrasound scans in a fully automated manner and is robust to quality variation of the datasets

Improving Outpatient Diabetes Care

More than 20% of patients in the Veterans Health Administration (VHA) have diabetes; therefore, disseminating “best practices” in outpatient diabetes care is paramount. The authors’ goal was to identify such practices and the factors associated with their development. First, a national VHA diabetes registry with 2008 data identified clinical performance based on the percentage of patients with an A1c \u3e9%. Facilities (n = 140) and community-based outpatient clinics (n = 582) were included and stratified into high, mid, and low performers. Semistructured telephone interviews (31) and site visits (5) were conducted. Low performers cited lack of teamwork between physicians and nurses and inadequate time to prepare. Better performing sites reported supportive clinical teams sharing work, time for non-face-to-face care, and innovative practices to address local needs. A knowledge management model informed our process. Notable differences between performance levels exist. “Best practices” will be disseminated across the VHA as the VHA Patient-Centered Medical Home model is implemented

Childbearing after liver transplantation

Seventeen female patients who underwent orthotopic liver transplantation between June 1973 and June 1987 became pregnant 5 months to 11 years after transplantation. Immunosuppression was maintained with combinations of prednisone, cyclosporine, and azathioprine prior to and during pregnancy. One patient discontinued immunosuppression after knowledge of pregnancy, taking only azathioprine sporadically. Mean age at time of delivery was 26 years. Twelve patients had no alteration in liver function studies; 7 patients demonstrated mild or moderate enzyme elevations prior to delivery, with one case of rejection confirmed by percutaneous liver biopsy. Major problems related to pregnancy were hypertension, anemia, and hyperbilirubinemia. Twenty live births occurred (2 patients had 2 separate pregnancies, one patient had a set of twins); 13 were by caesarian section, 7 by vaginal delivery. Eleven of the 13 caesarian births were premature by gestational age. All vaginal births were term. Toxemia of pregnancy and early rupture of membranes were the principal indications for caesarean section. There were no congenital abnormalities or birth defects and all the children are surviving well. Fifteen of 16 children older than one year all have normal physical and mental development, with one child manifesting immature speech development. Four children are under one year, all with normal milestones thus far. Sixteen of the 17 mothers are alive from 2—18 years after transplantation; the only death was from a lymphoma, almost 4 years after transplantation and 2½ years after delivery. This experience suggests that women undergoing liver transplantation can safely bear children despite an increased risk of premature caesarian births. The effect of chronic immunosuppression of female pediatric patients on their reproductive potential later in adulthood remains to be fully evaluated but the results so far are favorable. © 1990 by Williams & Wilkins