Real-Time Echocardiography Guidance for Optimized Apical Standard Views

Measurements of cardiac function such as left ventricular ejection fraction and myocardial strain are typically based on 2-D ultrasound imaging. The reliability of these measurements depends on the correct pose of the transducer such that the 2-D imaging plane properly aligns with the heart for standard measurement views and is thus dependent on the operator's skills. We propose a deep learning tool that suggests transducer movements to help users navigate toward the required standard views while scanning. The tool can simplify echocardiography for less experienced users and improve image standardization for more experienced users. Training data were generated by slicing 3-D ultrasound volumes, which permits simulation of the movements of a 2-D transducer. Neural networks were further trained to calculate the transducer position in a regression fashion. The method was validated and tested on 2-D images from several data sets representative of a prospective clinical setting. The method proposed the adequate transducer movement 75% of the time when averaging over all degrees of freedom and 95% of the time when considering transducer rotation solely. Real-time application examples illustrate the direct relation between the transducer movements, the ultrasound image and the provided feedback.publishedVersio

Earnings management in European real estate firms

Denne studien undersøker earnings management i eiendomssektoren. Mer spesifikt ser vi på virkningen av krise- og lederendring på earnings management. Dataene består av eiendomsselskaper notert på flere europeiske børser. Vi benytter skjønnsmessige periodiseringer fra fire forskjellige modeller, som et mål på earnings management. Modellene estimeres ved bruk av fixed effect regresjonsanalyser. De tre kriseperiodene vi undersøker er finanskrisen (2008-2009), lånekrisen (2011-2012) og Covid-pandemien (2020-2021). Resultatene våre indikerer mer inntektsreduserende aktiviteter i kriseperiodene. Når det gjelder lederskifte, gir to av fire modeller signifikant negativ effekt på skjønnsmessige periodiseringer, ved skifte av CEO. Våre resultater indikerer at lederskifte har en negativ effekt på earnings management. Vi finner likevel ikke sterke nok resultater til å påstå mer earnings management. Bidraget til denne studien er å fremme vår forståelse av hvordan ulike makroøkonomiske hendelser og firmaspesifikke faktorer påvirker earnings management

Earnings management in European real estate firms

Denne studien undersøker earnings management i eiendomssektoren. Mer spesifikt ser vi på virkningen av krise- og lederendring på earnings management. Dataene består av eiendomsselskaper notert på flere europeiske børser. Vi benytter skjønnsmessige periodiseringer fra fire forskjellige modeller, som et mål på earnings management. Modellene estimeres ved bruk av fixed effect regresjonsanalyser. De tre kriseperiodene vi undersøker er finanskrisen (2008-2009), lånekrisen (2011-2012) og Covid-pandemien (2020-2021). Resultatene våre indikerer mer inntektsreduserende aktiviteter i kriseperiodene. Når det gjelder lederskifte, gir to av fire modeller signifikant negativ effekt på skjønnsmessige periodiseringer, ved skifte av CEO. Våre resultater indikerer at lederskifte har en negativ effekt på earnings management. Vi finner likevel ikke sterke nok resultater til å påstå mer earnings management. Bidraget til denne studien er å fremme vår forståelse av hvordan ulike makroøkonomiske hendelser og firmaspesifikke faktorer påvirker earnings management

Bilirubin estimates from smartphone images of newborn infants’ skin correlated highly to serum bilirubin levels

Aim Neonatal jaundice is an important cause of morbidity and mortality, and identifying the condition remains a challenge. This study evaluated a novel method of estimating bilirubin levels from colour‐calibrated smartphone images. Methods A cross‐sectional prospective study was undertaken at two hospitals in Norway from February 2017 to March 2019, with standardised illumination at one hospital and non‐standardised illumination at the other hospital. Healthy term‐born infants with a normal birthweight were recruited up to 15 days of age. The main outcome measures were bilirubin estimates from digital images, plus total bilirubin in serum (TSB) and transcutaneous bilirubin (TcB). Results Bilirubin estimates were performed for 302 newborn infants, and 76 had severe jaundice. The correlation between the smartphone estimates and TSB was measured by Pearson's r and was .84 for the whole sample. The correlation between the image estimates and TcB was 0.81. There were no significant differences between the hospitals. Sensitivity was 100%, and specificity was 69% for identifying severe jaundice of more than 250 µmol/L. Conclusion A smartphone‐based tool that estimated bilirubin levels from digital images identified severe jaundice with high sensitivity and could provide a screening tool for neonatal jaundice

Skin-to-skin contact in the delivery room for very preterm infants: a randomised clinical trial

Objective Evaluating safety, feasibility and effects on physiological parameters of skin-to-skin contact (SSC) from birth between mothers and very preterm infants in a high-income setting.Design Open-label randomised controlled trial.Setting Three Norwegian neonatal units.Patients Preterm infants at gestational age (GA) 280–316 weeks and birth weight >1000g delivered vaginally or by caesarean section (C-section).Intervention Two hours of early SSC between the mother and the infant compared to standard care (SC) where the infant is separated from the mother and transferred to the neonatal unit in an incubator.Results 108 infants (63% male, 57% C-section, mean (SD) GA 30.3 weeks (1.3) and birth weight 1437 g (260)) were included. Median (IQR) age at randomisation was 23 min (17–30). During the first 2 hours after randomisation, 4% (2 of 51) and 7% (4 of 57) were hypothermic (<36.0°C) in the SSC and SC group, respectively (p=0.68, OR 0.5, 95% CI 0.1 to 3.1). Significantly fewer infants in the SSC group had hyperthermia (>37.5°C) (26% (13 of 57) vs 47% (27 of 51), respectively, p=0.02, OR 0.4, 95% CI 0.2 to 0.9). No infant needed mechanical ventilation within the first 2 hours. Median (IQR) duration of SSC was 120 (80–120) min in the intervention group. There was no difference in heart rate, respiratory rate and oxygen saturation between groups during the first 24 hours.Conclusion This study from a high-income setting confirmed that SSC from birth for very preterm infants was safe and feasible. Physiological parameters were not affected by the intervention. The long-term effects on neurodevelopment, maternal–infant bonding and maternal mental health will be collected.Trial registration number NCT02024854

Bilirubin estimates from smartphone images of newborn infants' skin correlated highly to serum bilirubin levels.

AIM: Neonatal jaundice is an important cause of morbidity and mortality, and identifying the condition remains a challenge. This study evaluated a novel method of estimating bilirubin levels from colour-calibrated smartphone images. METHODS: A cross-sectional prospective study was undertaken at two hospitals in Norway from February 2017 to March 2019, with standardised illumination at one hospital and non-standardised illumination at the other hospital. Healthy term-born infants with a normal birthweight were recruited up to 15 days of age. The main outcome measures were bilirubin estimates from digital images, plus total bilirubin in serum (TSB) and transcutaneous bilirubin (TcB). RESULTS: Bilirubin estimates were performed for 302 newborn infants, and 76 had severe jaundice. The correlation between the smartphone estimates and TSB was measured by Pearson's r and was .84 for the whole sample. The correlation between the image estimates and TcB was 0.81. There were no significant differences between the hospitals. Sensitivity was 100%, and specificity was 69% for identifying severe jaundice of more than 250 µmol/L. CONCLUSION: A smartphone-based tool that estimated bilirubin levels from digital images identified severe jaundice with high sensitivity and could provide a screening tool for neonatal jaundice

Inter-rater reliability of the Silverman and Andersen index-a measure of respiratory distress in preterm infants.

BackgroundThere are various methods of respiratory support available to optimize respiratory function in preterm infants. Respiratory scoring tools might provide information on which method to choose and the level and duration of support needed. Before implementing a respiratory scoring tool in our clinical practice, we aimed to test the inter- and intra-rater reliability of the Silverman and Andersen index (SA index) among neonatologists and nurses when applied to preterm infants on respiratory support. We also examined the association between the SA index and the electrical activity of the diaphragm (Edi signals).MethodsThis was a multicenter study including three newborn intensive care units in Norway. Four neonatologists and 10 nurses applied the SA index when assessing 80 videos of 44 preterm infants on High Flow Nasal Cannula, Continuous Positive Airway Pressure and Neurally Adjusted Ventilatory Assist. The inter- and intra-rater reliability for the sum scores were measured by the intra-class correlation coefficient (ICC), and Kendall's W was used to assess the degree of agreement for each item. We quantified the association between the Edi signals and the SA index scores by the Spearman's correlation coefficient.ResultsWe found poor inter-rater reliability with an ICC for absolute agreement of 0.34 (95% CI: 0.20 to 0.53). There was fair agreement measuring each item separately for upper chest movements (Kendall's W 0.30), and moderate for lower chest movements (0.43) and xiphoid retractions (0.44). Expiratory grunting showed substantial agreement (0.67). The intra-rater reliability was good (ICC for absolute agreement 0.77; 95% CI: 0.68 to 0.84). We found a moderate positive correlation (r = 0.468, p = 0.028) between the maximum inspiratory diaphragm activity (Edi peak) and the mean inspiratory SA index scores.ConclusionOur study showed poor inter-rater and good intra-rater reliability of the SA index when nurses and neonatologists assessed videos of preterm infants on various types of respiratory support. Edi peak and SA index had a moderate positive correlation. Formal training might be essential to improve the inter-rater reliability.Trial registrationRegistered 26th June 2017, ClinicalTrials.gov Identifier: NCT03199898