Development and evaluation of intraoperative ultrasound segmentation with negative image frames and multiple observer labels

When developing deep neural networks for segmenting intraoperative ultrasound images, several practical issues are encountered frequently, such as the presence of ultrasound frames that do not contain regions of interest and the high variance in ground-truth labels. In this study, we evaluate the utility of a pre-screening classification network prior to the segmentation network. Experimental results demonstrate that such a classifier, minimising frame classification errors, was able to directly impact the number of false positive and false negative frames. Importantly, the segmentation accuracy on the classifier-selected frames, that would be segmented, remains comparable to or better than those from standalone segmentation networks. Interestingly, the efficacy of the pre-screening classifier was affected by the sampling methods for training labels from multiple observers, a seemingly independent problem. We show experimentally that a previously proposed approach, combining random sampling and consensus labels, may need to be adapted to perform well in our application. Furthermore, this work aims to share practical experience in developing a machine learning application that assists highly variable interventional imaging for prostate cancer patients, to present robust and reproducible open-source implementations, and to report a set of comprehensive results and analysis comparing these practical, yet important, options in a real-world clinical application

Challenges to the provision of diabetes care in first nations communities: results from a national survey of healthcare providers in Canada

<p>Abstract</p> <p>Background</p> <p>Aboriginal peoples globally, and First Nations peoples in Canada particularly, suffer from high rates of type 2 diabetes and related complications compared with the general population. Research into the unique barriers faced by healthcare providers working in on-reserve First Nations communities is essential for developing effective quality improvement strategies.</p> <p>Methods</p> <p>In Phase I of this two-phased study, semi-structured interviews and focus groups were held with 24 healthcare providers in the Sioux Lookout Zone in north-western Ontario. A follow-up survey was conducted in Phase II as part of a larger project, the Canadian First Nations Diabetes Clinical Management and Epidemiologic (CIRCLE) study. The survey was completed with 244 healthcare providers in 19 First Nations communities in 7 Canadian provinces, representing three isolation levels (isolated, semi-isolated, non-isolated). Interviews, focus groups and survey questions all related to barriers to providing optimal diabetes care in First Nations communities.</p> <p>Results</p> <p>the key factors emerging from interviews and focus group discussions were at the patient, provider, and systemic level. Survey results indicated that, across three isolation levels, healthcare providers' perceived patient factors as having the largest impact on diabetes care. However, physicians and nurses were more likely to rank patient factors as having a large impact on care than community health representatives (CHRs) and physicians were significantly less likely to rank patient-provider communication as having a large impact than CHRs.</p> <p>Conclusions</p> <p>Addressing patient factors was considered the highest impact strategy for improving diabetes care. While this may reflect "patient blaming," it also suggests that self-management strategies may be well-suited for this context. Program planning should focus on training programs for CHRs, who provide a unique link between patients and clinical services. Research incorporating patient perspectives is needed to complete this picture and inform quality improvement initiatives.</p

Unikkaartuit: Meanings and Experiences of Suicide Among Inuit in Nunavut, Canada

Inuit in Arctic Canada have one of the highest suicide rates in the world. Most of these suicides occur among youth, especially males, between the ages of 15 and 24. The goal of this study was to gain an understanding of Inuit experiences with suicide and what suicide means to Inuit, including suicide attempters and bereaved survivors. Fifty Inuit between the ages of 14 and 94 were interviewed about suicides in two communities in Nunavut. Sixty-three high school and college students were also surveyed with the same questions. It was found that suicide was most closely related to romantic relationship and family problems, and to experiences of loneliness and anger. These findings are interpreted in the context of massive social change, on-going colonization, and multigenerational trauma following the colonial government era of the 1950s and 1960s, when family and interpersonal relationships were significantly affected. The study stresses that suicide prevention strategies focus on youth and family, particularly on parenting, and ensure that Inuit communities take control of prevention programs. It recommends that family and community resources be further mobilized for suicide prevention