Pixel classification for automated diabetic foot diagnosis

Worldwide, more than 180 million people suffer from diabetes mellitus. Approximately 50% of these patients will develop complications to their feet. Neuropathy, combined with poor blood supply and biomechanical changes results in a high risk for foot ulcers, which is a key problem in the diabetic foot; when these wounds become infected, this can ultimately result in lower extremity amputation, which has a serious effect on the quality of life of the patient, and causes a large economic burden on society.\ud \ud This was the motivation for a collaborate project (Vincent50) in which a photographic foot imaging device was developed. The system allows scanning of the foot soles on a daily basis which may lead to early recognition of foot problems. The goal of the present study is to determine whether pixel classification is a useful intermediate step towards automatically assessing the images of the foot soles for signs of diabetic foot disease. If successful, this approach will further relief health care professionals in assessing the foot and enable the placement of more devices in the future. \ud \ud The best agreement between automated recognition and expert diagnosis was achieved with a combination of RGB and derived features, proves that the RGB data is informative with respect to detection of ulcers. However, the automatic detection of pre-signs of ulcers and other anomalies needs more sophistication than pixel classification alone. Firstly, other physical features, such as hyperspectral data, infrared and/or textural features are expected to be more informative. Secondly, we expect to be able to boost the performance by using the context between neighboring pixels. Thirdly, an individualized and normalized classification process might help with the large variability in foot soles between individuals. \u

Drought at the global scale in the 2nd part of the 20th century (1963-2001)

The large impacts of drought on society, economy and environment urge for a thorough investigation. A good knowledge of past drought events is important for both understanding of the processes causing drought, as well as to provide reliability assessments for drought projections for the future. Preferably, the investigation of historic drought events should rely on observations. Unfortunately, for a global scale these detailed observations are often not available. Therefore, the outcome of global hydrological models (GHMs) and off-line land surface models (LSMs) is used to assess droughts. In this study we have investigated to what extent simulated gridded time series from these large-scale models capture historic hydrological drought events. Results of ten different models, both GHMs and LSMs, made available by the WATCH project, were compared. All models are run on a global 0.5 degree grid for the period 1963-2000 with the same meteorological forcing data (WATCH forcing data). To identify hydrological drought events, the monthly aggregated total runoff values were used. Different methods were developed to identify spatio-temporal drought characteristics. General drought characteristics for each grid cell, as for example the average drought duration, were compared. These characteristics show that when comparing absolute values the models give substantially different results, whereas relative values lead to more or less the same drought pattern. Next to the general drought characteristics, some documented major historical drought events (one for each continent) were selected and described in more detail. For each drought event, the simulated drought clusters (spatial events) and their characteristics are given for one month during the event. It can be concluded that most major drought events are captured by all models. However, the spatial extent of the drought events differ substantially between the models. In general the models show a fast reaction to rainfall and therefore also capture drought events caused by large rainfall anomalies. More research is still needed, since here we only looked at a few selected number of documented drought events spread over the globe. To assess more in detail if these large-scale models are able to capture drought, additional quantitative analyses are needed together with a more elaborated comparison against observed drought events

Initiation of home mechanical ventilation at home:A randomised controlled trial of efficacy, feasibility and costs

SummaryIntroductionHome mechanical ventilation (HMV) in the Netherlands is normally initiated in hospital, but this is expensive and often a burden for the patient. In this randomised controlled study we investigated whether initiation of HMV at home in patients with chronic respiratory failure is non-inferior to an in hospital based setting.MethodsSeventy-seven patients were included, of which 38 patients started HMV at home. All patients were diagnosed with chronic respiratory failure due to a neuromuscular or thoracic cage disease. Primary outcome was the arterial carbon dioxide (PaCO2) while quality of life and costs were secondary outcomes. Telemonitoring was used in the home group to provide therapeutic information, for example; transcutaneous carbon dioxide, oxygen saturation and ventilator information, to the caregivers. Follow-up was six months.ResultsPaCO2, improved by 0.72 (SE ± 0.16) kPa in the hospital group and by 0.91 (±0.20) in the home group, both improvements being significant and the latter clearly not inferior.There were also significant improvements in quality of life in both groups, again not being inferior with home treatment.ConclusionThis study is the first to show that initiation of HMV at home in a selective group of patients with chronic respiratory failure is as effective for gas exchange and quality of life as hospital initiation. In addition we found that it is safe, technically feasible and that more than € 3000 per patient can be saved compared to our standard care

Dé juiste lezing bestaat niet! Hoe je vanuit een open houding tot dialogisch leesonderwijs komt

Vaak behandelen we teksten in de klas ten onrechte alsof er maar één mogelijke interpretatie is, waarbij leraren het als hun taak zien om hun leerlingen mee te nemen in die ene ‘ juiste lezing’. Vaak zijn er echter meerdere interpretaties mogelijk en kan de visie die uit de tekst spreekt kritisch benaderd worden. Dat zou leerzame gesprekken opleveren. Dit artikel bespreekt hoe een dialogische aanpak in het leesonderwijs ook al op basisscholen kan helpen om leraren en leerlingen gelijkwaardig en kritischer te laten nadenken over tekstbetekenissen. Hierbij is de benadering die leraren (en leerlingen) tegenover teksten aannemen cruciaal. Welke benadering stimuleert een goede dialoog over een tekst? En wat betekent dit voor de tekstkeuze en voor wat leraren moeten weten en kunnen

GATA2 haploinsufficient patients lack innate lymphoid cells that arise after hematopoietic cell transplantation.

Innate lymphoid cells (ILC) are important barrier tissue immune regulators. They play a pivotal role in early non-specific protection against infiltrating pathogens, regulation of epithelial integrity, suppression of pro-inflammatory immune responses and shaping the intestinal microbiota. GATA2 haploinsufficiency causes an immune disorder that is characterized by bone marrow failure and (near) absence of monocytes, dendritic cells, B cells and natural killer (NK) cells. T cells develop normally, albeit at lower numbers. Here, we describe the absence of ILCs and their progenitors in blood and bone marrow of two patients with GATA2 haploinsufficiency and show that all subsets of ILCs appear after allogeneic hematopoietic stem cell transplantation, irrespective of the preparative conditioning regimen. Our data indicate that GATA2 is involved in the development of hematopoietic precursor cells (HPC) towards the ILC lineage

First European consensus for diagnosis, management, and treatment of transthyretin familial amyloid polyneuropathy

Purpose of reviewEarly and accurate diagnosis of transthyretin familial amyloid polyneuropathy (TTR-FAP) represents one of the major challenges faced by physicians when caring for patients with idiopathic progressive neuropathy. There is little consensus in diagnostic and management approaches across Europe.Recent findingsThe low prevalence of TTR-FAP across Europe and the high variation in both genotype and phenotypic expression of the disease means that recognizing symptoms can be difficult outside of a specialized diagnostic environment. The resulting delay in diagnosis and the possibility of misdiagnosis can misguide clinical decision-making and negatively impact subsequent treatment approaches and outcomes.SummaryThis review summarizes the findings from two meetings of the European Network for TTR-FAP (ATTReuNET). This is an emerging group comprising representatives from 10 European countries with expertise in the diagnosis and management of TTR-FAP, including nine National Reference Centres. The current review presents management strategies and a consensus on the gold standard for diagnosis of TTR-FAP as well as a structured approach to ongoing multidisciplinary care for the patient. Greater communication, not just between members of an individual patient's treatment team, but also between regional and national centres of expertise, is the key to the effective management of TTR-FAP.</p

Tissue biopsy for the diagnosis of amyloidosis: experience from some centres

A reliable diagnosis of amyloidosis is usually based on a tissue biopsy. With increasing options for specific treatments of the different amyloid diseases, an exact and valid diagnosis including determination of the biochemical fibril nature is imperative. Biopsy sites as well as amyloid typing principles vary and this paper describes methods employed at some laboratories specialised in amyloidosis in Europe, Japan and USA

Text structure instruction in primary education: Effects on reading, summarization, and writing

Although knowledge of informational text structures can promote text comprehension, this topic receives little attention in the Dutch primary school curriculum. 201 Dutch students in grades 4-6 participated with their teachers (n = 10) in this quasi-experimental study with a switching-panels replication design. Students either first followed a text structure intervention (TOP) and then went back to business-as-usual, or the other way around. During the intervention, teachers taught their students about the characteristics of four informational text structures, and how to use structure-specific graphic organizers to organize main ideas for each structure. In addition, several writing tasks related to the different text structures were included. At three measurement occasions, students completed text structure tests, reading comprehension tests, summarization tasks, and writing tasks. Only the fourth graders in one iteration of the intervention showed immediate effects over and above the effect of business-as-usual lessons on the text structure test (d = 0.50), the reading comprehension test (d = 0.53), the summarization task (d = 0.48). In both iterations of the intervention, an immediate effect was found on writing (d = 0.33 and d = 0.39). These findings are discussed in the light of test-related issues and implementation fidelity data

Global multimodel analysis of drought in runoff for the second half of the twentieth century

During the past decades large-scale models have been developed to simulate global and continental terrestrial water cycles. It is an open question whether these models are suitable to capture hydrological drought, in terms of runoff, on global scale. A multi-model ensemble analysis was carried out to evaluate if ten of such large-scale models agree on major drought events during the second half of the 20th century. Time series of monthly precipitation, monthly total runoff from ten global hydrological models, and their ensemble median have been used to identify drought. Temporal development of area in drought for various regions across the globe was investigated. Model spread was largest in regions with low runoff and smallest in regions with high runoff. In vast regions, correlation between runoff drought derived from the models and meteorological drought was found to be low. This indicated that models add information to the signal derived from precipitation and that runoff drought cannot directly be determined from precipitation data alone in global drought analyses with a constant aggregation period. However, duration and spatial extent of major drought events differed between models. Some models showed a fast runoff response to rainfall, which led to deviations from reported drought events in slowly responding hydrological systems. By using an ensemble of models, this fast runoff response was partly overcome and delay in drought propagating from meteorological drought to drought in runoff was included. Finally, an ensemble of models also allows to consider uncertainty associated with individual model structures