Multilevel Thresholding for Image Segmentation Using an Improved Electromagnetism Optimization Algorithm

Image segmentation is considered one of the most important tasks in image processing, which has several applications in different areas such as; industry agriculture, medicine, etc. In this paper, we develop the electromagnetic optimization (EMO) algorithm based on levy function, EMO-levy, to enhance the EMO performance for determining the optimal multi-level thresholding of image segmentation. In general, EMO simulates the mechanism of attraction and repulsion between charges to develop the individuals of a population. EMO takes random samples from search space within the histogram of image, where, each sample represents each particle in EMO. The quality of each particle is assessed based on Otsu’s or Kapur objective function value. The solutions are updated using EMO operators until determine the optimal objective functions. Finally, this approach produces segmented images with optimal values for the threshold and a few number of iterations. The proposed technique is validated using different standard test images. Experimental results prove the effectiveness and superiority of the proposed algorithm for image segmentation compared with well-known optimization methods

A comparative randomized clinical trial evaluating the efficacy and safety of tacrolimus versus hydrocortisone as a topical treatment of atopic dermatitis in children

Background: Atopic dermatitis (AD) aetiology is not exactly identified, but it is characterized by pruritic skin reactions with elevation in the levels of inflammatory markers. Despite the fact that Corticosteroids are the mainstay therapy in the management of AD, they have many local and systemic adverse effects.Objective: The aim of this study is to evaluate the efficacy and safety of topical tacrolimus ointment in comparison to topical hydrocortisone cream in the management of the AD of children diagnosed with AD.Patients and Methods: This study was conducted on 200 children with AD. They were simply randomized into two groups, the tacrolimus group treated with 0.03% topical tacrolimus ointment and the hydrocortisone group treated with 1% hydrocortisone cream twice daily during the 3 weeks study period.Results: At the end of the study, both the tacrolimus and hydrocortisone groups showed a significant decline in the mean serum level of IL-10, IL-17, and IL-23 (p < 0.05) when compared to their baseline levels. However, the tacrolimus group showed a more significant decrease (p < 0.05) in the mean serum level of IL-10, IL-17, and IL-23 as compared to the hydrocortisone group [Mean differences = 1.600, 95% CI: 0.9858–2.214; 1.300, 95% CI: 1.086–1.514 and 4.200, 95% CI: 3.321–5.079]. Moreover, the median mEASI decreased similarly from 32 to 21 in the tacrolimus group and from 30 to 22 in the hydrocortisone group (p > 0.05) [Median difference = −2.000, 95% CI: −2.651 to −1.349; Median difference = 1.000, 95% CI: 0.3489–1.651]. Mild to moderate transient stinging and erythema were the main adverse effects that showed higher incidence in the tacrolimus group than in the hydrocortisone group (p < 0.05). In most cases, they resolved within 3–4 days. Besides, tacrolimus ointment did not cause skin atrophy as compared to the hydrocortisone group (p < 0.05).Conclusion: Tacrolimus ointment is more beneficial than hydrocortisone cream in managing AD in children in terms of lowering the inflammatory markers, however, there is no difference on the dermatitis severity scale. Moreover, tacrolimus is safer with a better side effect profile compared to hydrocortisone.Trial Registration: The trial is registered at ClinicalTrials.gov (CT.gov identifier: NCT05324618

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Multilevel Thresholding for Image Segmentation Using an Improved Electromagnetism Optimization Algorithm

Image segmentation is considered one of the most important tasks in image processing, which has several applications in different areas such as; industry agriculture, medicine, etc. In this paper, we develop the electromagnetic optimization (EMO) algorithm based on levy function, EMO-levy, to enhance the EMO performance for determining the optimal multi-level thresholding of image segmentation. In general, EMO simulates the mechanism of attraction and repulsion between charges to develop the individuals of a population. EMO takes random samples from search space within the histogram of image, where, each sample represents each particle in EMO. The quality of each particle is assessed based on Otsu’s or Kapur objective function value. The solutions are updated using EMO operators until determine the optimal objective functions. Finally, this approach produces segmented images with optimal values for the threshold and a few number of iterations. The proposed technique is validated using different standard test images. Experimental results prove the effectiveness and superiority of the proposed algorithm for image segmentation compared with well-known optimization methods

Multilevel Thresholding for Image Segmentation Using an Improved Electromagnetism Optimization Algorithm

Image segmentation is considered one of the most important tasks in image processing, which has several applications in different areas such as; industry agriculture, medicine, etc. In this paper, we develop the electromagnetic optimization (EMO) algorithm based on levy function, EMO-levy, to enhance the EMO performance for determining the optimal multi-level thresholding of image segmentation. In general, EMO simulates the mechanism of attraction and repulsion between charges to develop the individuals of a population. EMO takes random samples from search space within the histogram of image, where, each sample represents each particle in EMO. The quality of each particle is assessed based on Otsu’s or Kapur objective function value. The solutions are updated using EMO operators until determine the optimal objective functions. Finally, this approach produces segmented images with optimal values for the threshold and a few number of iterations. The proposed technique is validated using different standard test images. Experimental results prove the effectiveness and superiority of the proposed algorithm for image segmentation compared with well-known optimization method

A complexity efficient PAPR reduction scheme for FBMC-based VLC systems

Visible light communication based on a filter bank multicarrier holds enormous promise for optical wireless communication systems, due to its high-speed and unlicensed spectrum. Moreover, visible light communication techniques greatly impact communication links for small satellites like cube satellites, and pico/nano satellites, in addition to inter-satellite communications between different satellite types in different orbits. However, the transmitted visible signal via the filter bank multicarrier has a high amount of peak-to-average power ratio, which results in severe distortion for a light emitting diode output. In this work, a scheme for enhancing the peak-to-average power ratio reduction amount is proposed. First, an algorithm based on generating two candidates signals with different peak-to- average power ratio is suggested. The signal with the lowest ratio is selected and transmitted. Second, an alternate direct current-biased approach, which is referred to as the addition reversed method, is put forth to transform transmitted signal bipolar values into actual unipolar ones. The performance is assessed through a cumulative distribution function of peak-to-average power ratio, bit error rate, power spectral density, and computational complexity. The simulation results show that, compared to other schemes in literature, the proposed scheme attains a great peak-to-average power ratio reduction and improves the bit the error rate performance with minimum complexity overhead. The proposed approach achieved about 5 dB reduction amount compared to companding technique, 5.5 dB compared to discrete cosine transform precoding, and 8 dB compared to conventional direct current bias of an optical filter bank multicarrier. Thus, the proposed scheme reduces the complexity overhead by 15.7% and 55.55% over discrete cosine transform and companding techniques, respectively

Efficacy of ultrasonography-guided intra-articular steroid injection of the shoulder and excercising in patients with adhesive capsulitis: Glenohumeral versus subacromial approaches

Aim of the work: To evaluate the efficacy of intra-articular steroid injection of the shoulder joint with exercises in the management of patients with adhesive capsulitis and to compare glenohumeral (GH) versus subacromial subdeltoid (SASD) ultrasound-guided approaches. Patients and methods: Forty patients with adhesive capsulitis were randomly divided into 2 groups according to injection approach. Patients received ultrasound-guided intra-articular injection methylprednisolone acetate (40 mg) and 1 ml 2% lidocaine followed by exercise for 12 weeks. Visual analog scale (VAS) for pain, the shoulder pain and disability index (SPADI) and active range of motion (ROM) were assessed before and 12 weeks post-injection. Results: The mean age of the patients was 47.3 ± 8.7 years with 12 females and 8 males in each group. After injection, there was a significant improvement of pain (VAS) and SPADI in both groups (p < 0.001). Before injection, SASD bursitis was present in 18 (45%), GH joint effusion in 14 (35%), rotator cuff tendinopathy in 6 (15%), bursitis with effusion in 1 (2.5%) and with supraspinatus tendon calcification in another (2.5%). Both groups significantly equally improved regarding to ROM compared to before injection. Post-injection, the SPADI significantly improved in the SASD group compared to GH; with remarkable improvement in the joint extension, internal and external rotation (p < 0.001). Conclusion: Intrarticular steroid injection of the shoulder joint followed by exercises in patients with adhesive capsulitis decreases pain, improves function and ROM with a more favorable response by the GH approach. Ultrasound-guided injection is an accurate, easy and cost-effective approach. Keywords: Adhesive capsulitis, Glenohumeral, Subacromial subdeltoid bursa, Ultrasound-guided injectio

Efficacy and cost effectiveness of intravenous ferric carboxymaltose versus iron sucrose in adult patients with iron deficiency anaemia

Background Iron deficiency anaemia (IDA) is a major health issues and common type of nutritional deficiency worldwide. For IDA treatment, intravenous (IV) iron is a useful therapy. Objective To determine the efficacy and cost-effectiveness (CE) of intravenous (IV) Ferric Carboxymaltose (FCM) versus IV Iron Sucrose (IS) in treating IDA. Data sources Electronic medical record i.e. Cerner system. Target population Adults patients with iron deficiency anaemia. Time horizon A 12-month period (01/01/2018-31/12/2018). Perspective Hamad Medical Corporation (HMC, a public hospital). Intervention IV Ferric Carboxymaltose versus IV Iron Sucrose. Outcome measures With regard to responses to treatment i.e., efficacy of treatment with FCM &amp; IS in IDA patients, hemoglobin (Hgb), ferritin, and transferrin saturation (TSAT) levels were the primary outcomes. Additionally, the researchers also collected levels of iron, platelet, white blood cell (WBC), red blood cell (RBC), mean corpuscular hemoglobin (MCH), and mean corpuscular volume (MCV). The costs i.e. resources consumed (obtained from NCCCR-HMC) and the CE of FCM versus IS were the secondary outcomes. Results of base-case analysis There was a significant improvement in Hgb, RBC and MCH levels in the IS group than the FCM group. The overall cost of IS therapy was significantly higher than FCM. The medication cost for FCM was approximately 6.5 times higher than IS, nonetheless, it is cheaper in terms of bed cost and nursing cost. The cost effectiveness (CE) ratio illustrated that FCM and IS were significantly different in terms of Hgb, ferritin and MCH levels. Further, Incremental Cost Effectiveness Ratio (ICER) indicated that further justifications and decisions need to be made for FCM when using Hgb, iron, TSAT, MCH and MCV levels as surrogate outcomes. Results of sensitivity analysis Not applicable. Limitations The study did not consider the clinical or humanistic outcome. Conclusions The higher cost of FCM versus IS can be offset by savings in healthcare personnel time and bed space. ICER indicated that further justifications and decisions need to be made for FCM when using Hgb, iron, TSAT, MCH and MCV levels as surrogate outcomes.Scopu

Accuracy of the Traditional COVID-19 Phone Triaging System and Phone Triage-Driven Deep Learning Model

Objectives: During the COVID-19 pandemic, a quick and reliable phone-triage system is critical for early care and efficient distribution of hospital resources. The study aimed to assess the accuracy of the traditional phone-triage system and phone triage-driven deep learning model in the prediction of positive COVID-19 patients. Setting: This is a retrospective study conducted at the family medicine department, Cairo University. Methods: The study included a dataset of 943 suspected COVID-19 patients from the phone triage during the first wave of the pandemic. The accuracy of the phone triaging system was assessed. PCR-dependent and phone triage-driven deep learning model for automated classifications of natural human responses was conducted. Results: Based on the RT-PCR results, we found that myalgia, fever, and contact with a case with respiratory symptoms had the highest sensitivity among the symptoms/ risk factors that were asked during the phone calls (86.3%, 77.5%, and 75.1%, respectively). While immunodeficiency, smoking, and loss of smell or taste had the highest specificity (96.9%, 83.6%, and 74.0%, respectively). The positive predictive value (PPV) of phone triage was 48.4%. The classification accuracy achieved by the deep learning model was 66%, while the PPV was 70.5%. Conclusion: Phone triage and deep learning models are feasible and convenient tools for screening COVID-19 patients. Using the deep learning models for symptoms screening will help to provide the proper medical care as early as possible for those at a higher risk of developing severe illness paving the way for a more efficient allocation of the scanty health resources