Towards automated visual flexible endoscope navigation

Background:\ud The design of flexible endoscopes has not changed significantly in the past 50 years. A trend is observed towards a wider application of flexible endoscopes with an increasing role in complex intraluminal therapeutic procedures. The nonintuitive and nonergonomical steering mechanism now forms a barrier in the extension of flexible endoscope applications. Automating the navigation of endoscopes could be a solution for this problem. This paper summarizes the current state of the art in image-based navigation algorithms. The objectives are to find the most promising navigation system(s) to date and to indicate fields for further research.\ud Methods:\ud A systematic literature search was performed using three general search terms in two medical–technological literature databases. Papers were included according to the inclusion criteria. A total of 135 papers were analyzed. Ultimately, 26 were included.\ud Results:\ud Navigation often is based on visual information, which means steering the endoscope using the images that the endoscope produces. Two main techniques are described: lumen centralization and visual odometry. Although the research results are promising, no successful, commercially available automated flexible endoscopy system exists to date.\ud Conclusions:\ud Automated systems that employ conventional flexible endoscopes show the most promising prospects in terms of cost and applicability. To produce such a system, the research focus should lie on finding low-cost mechatronics and technologically robust steering algorithms. Additional functionality and increased efficiency can be obtained through software development. The first priority is to find real-time, robust steering algorithms. These algorithms need to handle bubbles, motion blur, and other image artifacts without disrupting the steering process

Multimodal discourse on online newspaper home pages: A social-semiotic perspective

In a short space of time, online newspapers have emerged to play an important role in the institutional construction of ‘news’ and the mass mediation of information. The home pages of online newspapers feature short verbal texts, and communicate using language, image, layout, colour, and other semiotic resources: they communicate multimodally. This thesis examines the multimodal discourse of three English-language online newspapers: the Bangkok Post (Thailand), the English-language edition (translated from Chinese) of the People’s Daily (China), and the Sydney Morning Herald (Australia). Between February, 2002 and April, 2006, three data collections were made (February-April, 2002; September-November, 2005; January-April, 2006) using a five-day ‘constructed week’ method. The main corpus was 15 home pages from each newspaper (five per collection per newspaper), but the total corpus (including other pages from each newspaper) was 603 web pages. Two senior editors (one each from the Bangkok Post and the Sydney Morning Herald) were interviewed. The multimodal discourse of the home pages was analysed using tools from Systemic Functional Multimodal Discourse Analysis (SF-MDA), and a ‘visual grammar’ of home pages building on the work of Kress & van Leeuwen (1996) was developed. In addition, a rank scale for online newspapers was proposed, and limitations of applying the tool of rank scale to this corpus were identified. An emerging genre - the headline-plus-lead-plus-hyperlink newsbite - was identified, and the design of newsbites on the home page of the Sydney Morning Herald and the evolution of their design over time was analysed. The use of images on the home pages in the corpus was analysed, and the increasing use of thumbnail images in the Sydney Morning Herald - particularly close-up thumbnails of faces - was investigated in further depth. The visual design of online newspaper home pages and the news texts appearing on them are an evolution of print news genres and their design practices. Newsbites and headline-only newsbits are verbally short, so the authors of newspaper home pages are forced to rely increasingly on visual communication in order to position stories and readers, and to communicate the values of the news institution on the home page as mediated by the screen. Thumbnail images are evolving as a new form of punctuation on some home pages, and this may be a short-lived, or an emerging historical trend in the development of punctuation, at least in online environments. Overall, online newspaper home pages are tending towards shorter texts, which communicate in novel ways. These short texts cannot communicate the values and ideology of news institutions in the way that extended verbal texts have done for centuries, yet this function of news texts remains important to the construction and maintenance of a readership, and therefore crucial to the home page of a newspaper. As a result, news institutions express values visually in their design of newspaper home pages. As readers become familiar with the meanings of online news design, they become adept at reading and understanding short stories within these multimodally-construed frames of reference. Ideology is increasingly fragmented on shorter timescales, but expressed over longer timescales in a hypermedia environment that affords and extends many of the pre-existing multimodal features of print newspaper discourse

Conversion to sirolimus for chronic renal allograft dysfunction: risk factors for graft loss and severe side effects

We retrospectively reviewed our experience with 45 kidney transplant recipients (KTR) that were switched from CNI to SRL, mainly for chronic allograft dysfunction (CAD) (41/45). The mean serum creatinine at switch was 2.5 ± 0.8 mg/dl. At 1 year, patient survival was 93%. Death-censored graft survival was 67% at 1 year and 54% at 2 years. SRL was stopped because of severe side effects in 15 patients. Among these, eight patients developed ‘de novo’ high-grade proteinuria. Univariate analysis revealed that (1) a higher SRL level at 1 month was a predictor of SRL withdrawal due to severe side effects (P = 0.006), and (2) predictors of graft failure after SRL conversion were low SRL loading dose (P = 0.03) and a higher creatinine level at conversion (P = 0.003)

Interruption of cancer screening services due to COVID-19 pandemic: lessons from previous disasters

Purpose: To review the scientific literature seeking lessons for the COVID-19 era that could be learned from previous health services interruptions that affected the delivery of cancer screening services. Methods: A systematic search was conducted up to April 17, 2020, with no restrictions on language or dates and resulted in 385 articles. Two researchers independently assessed the list and discussed any disagreements. Once a consensus was achieved for each paper, those selected were included in the review. Results: Eleven articles were included. Three studies were based in Japan, two in the United States, one in South Korea, one in Denmark, and the remaining four offered a global perspective on interruptions in health services due to natural or human-caused disasters. No articles covered an interruption due to a pandemic. The main themes identified in the reviewed studies were coordination, communication, resource availability and patient follow-up. Conclusion: Lessons learned applied to the context of COVID-19 are that coordination involving partners across the health sector is essential to optimize resources and resume services, making them more resilient while preparing for future interruptions. Communication with the general population about how COVID-19 has affected cancer screening, measures taken to mitigate it and safely re-establish screening services is recommended. Use of mobile health systems to reach patients who are not accessing services and the application of resource-stratified guidelines are important considerations. More research is needed to explore best strategies for suspending, resuming and sustaining cancer screening programs, and preparedness for future disruptions, adapted to diverse health care systems

Potential of a cyclone prototype spacer to improve in vitro dry powder delivery

Copyright The Author(s) 2013. This article is published with open access at Springerlink.com. This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are creditedPurpose: Low inspiratory force in patients with lung disease is associated with poor deagglomeration and high throat deposition when using dry powder inhalers (DPIs). The potential of two reverse flow cyclone prototypes as spacers for commercial carrierbased DPIs was investigated. Methods: Cyclohaler®, Accuhaler® and Easyhaler® were tested with and without the spacers between 30-60 Lmin-1. Deposition of particles in the next generation impactor and within the devices was determined by high performance liquid chromatography. Results: Reduced induction port deposition of the emitted particles from the cyclones was observed due to the high retention of the drug within the spacers (e.g. salbutamol sulphate (SS): 67.89 ± 6.51 % at 30 Lmin-1 in Cheng 1). Fine particle fractions of aerosol as emitted from the cyclones were substantially higher than the DPIs alone. Moreover, the aerodynamic diameters of particles emitted from the cyclones were halved compared to the DPIs alone (e.g. SS from the Cyclohaler® at 4 kPa: 1.08 ± 0.05 μm vs. 3.00 ± 0.12 μm, with and without Cheng 2, respectively) and unaltered with increased flow rates. Conclusion: This work has shown the potential of employing a cyclone spacer for commercial carrier-based DPIs to improve inhaled drug delivery.Peer reviewe

Risk-stratified approach to breast cancer screening in canada: Women’s knowledge of the legislative context and concerns about discrimination from genetic and other predictive health data

The success of risk-stratified approaches in improving population-based breast cancer screening programs depends in no small part on women’s buy-in. Fear of genetic discrimination (GD) could be a potential barrier to genetic testing uptake as part of risk assessment. Thus, the objective of this study was twofold. First, to evaluate Canadian women’s knowledge of the legislative context governing GD. Second, to assess their concerns about the possible use of breast cancer risk levels by insurance companies or employers. We use a cross-sectional survey of 4293 (age: 30–69) women, conducted in four Canadian provinces (Alberta, British Colombia, Ontario and Québec). Canadian women’s knowledge of the regulatory framework for GD is relatively limited, with some gaps and misconceptions noted. About a third (34.7%) of the participants had a lot of concerns about the use of their health information by employers or insurers; another third had some concerns (31.9%), while 20% had no concerns. There is a need to further educate and inform the Canadian public about GD and the legal protections that exist to prevent it. Enhanced knowledge could facilitate the implementation and uptake of risk prediction informed by genetic factors, such as the risk-stratified approach to breast cancer screening that includes risk levels