Intelligent fetal monitoring and decision support in the management of labour

Merged with duplicate record 10026.1/675 on 01.02.2017 by CS (TIS)The condition of the fetus during labour is inferred from the continuous plot of fetal heart rate and uterine contractions (cardiotocogram, CTG). This can be _ difficult to interpret which results in both unnecessary intervention and a failure to intervene when necessary causing potentially preventable neurological damage and mortality. Conventional computing approaches have not been successful in addressing these problems. This is perhaps because the correct interpretation of fetal condition requires physiological knowledge, considerable practical experience and knowledge of the specific patient. The work described in this thesis is concerned with the investigation of artificial intelligence techniques to assist in the interpretation of fetal condition and advise on labour management. A fundamental investigation examined the performance of five types of scalp electrodes for obtaining the fetal electrocardiogram (ECG), from which heart rate is derived, and examined the factors which hamper fetal ECG data acquisition. New methods were developed to classify the important features from the CTG and included an investigation using neural networks. Other CTG features were classified using novel numerical algorithms developed closely with experts. An expert system, guided by a database of rules obtained from experts, was used to process and interpret changes in the CTG features by taking account of patient specific information. This hybrid approach was adopted to improve performance and reliability. After two internal evaluations had found the system obtained a performance comparable with local experts, an extensive external validation was undertaken. This study involved 17 experts from 16 leading centres within the UK. Each expert and the system reviewed 50 cases twice, at least one month apart which contained those considered most difficult to interpret selected from a database of 2400 high risk labours. A novel method was developed to present all the relevant clinical information in a way which approximated the clinical situation. The reviewers scored each 15 minutes of recording according to the concern they had for the fetus and the management they considered appropriate. In this respect, this is the first reported study to examine the performance of expert obstetricians in the management of labour. A new method was derived to measure the agreement between the scores obtained and is applicable to other areas where it is required to measure the similarity between time related sequences. This study found that the experts agreed well and were consistent in their management of the cases. The system was indistinguishable from the experts, except it was more consistent, even when used by an engineer with little knowledge of labour management. This study has shown that expertise in fetal monitoring is achievable in which case the current evidence suggests that this is not being adequately transferred to clinicians. The challenge remains to formulate a method to effectively transfer knowledge to the labour ward and thereby address the real and practical problems which face fetal monitoring today. This study demonstrates that intelligent systems could provide the vehicle to achieve this. I dedicate this work to the memory of my father, Bradley Kenneth Keith with a hope that he always believed it possible. I know he would have had some interesting comments to make and I sadly miss the opportunity of discussing them with him. I also dedicate this work to my mother for always being there, and to my wife Michelle for her unwavering support, patience and most of all her encouragement throughout this work.The Science and Engineering Research Council, Northcott Devon Medical Foundation, Polytechnic Central Funding Council, Mason Medical Research Foundation and The Royal Academy of Engineering

Enhancing Cloud Security and Privacy: The Power and the Weakness of the Audit Trail

Winner of best paper award.Publisher PD

Enhancing Cloud Security and Privacy: The Cloud Audit Problem

Publisher PD

Enhancing Cloud Security and Privacy : The Unikernel Solution

Postprin

Netrin-1-Mediated Axon Guidance in Mouse Embryonic Stem Cells Overexpressing Neurogenin-1

Stem cell therapy holds great promise for treating neurodegenerative disease, but major barriers to effective therapeutic strategies remain. A complete understanding of the derived phenotype is required for predicting cell response once introduced into the host tissue. We sought to identify major axonal guidance cues present in neurons derived from the transient overexpression of neurogenin-1 (Neurog1) in mouse embryonic stem cells (ESCs). Neurog1 upregulated the netrin-1 axon guidance receptors DCC (deleted in colorectal cancer) and neogenin (NEO1). Quantitative polymerase chain reaction results showed a 2-fold increase in NEO1 mRNA and a 36-fold increase in DCC mRNA in Neurog1-induced compared with control ESCs. Immunohistochemistry indicated that DCC was primarily expressed on cells positive for the neuronal marker TUJ1. DCC was preferentially localized to the cell soma and growth-cones of induced neurons. In contrast, NEO1 expression showed less specificity, labeling both TUJ1-positive and TUJ1-negative cells as well as uninduced control cells. Axonal outgrowth was directed preferentially toward aggregates of HEK293 cells secreting a recombinant active fragment of netrin-1. These data indicate that DCC and NEO1 are downstream products of Neurog1 and may guide the integration of Neurog1-induced ESCs with target cells secreting netrin-1. Differential expression profiles for netrin receptors could indicate different roles for this guidance cue on neuronal and non-neuronal cells.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98473/1/scd%2E2011%2E0437.pd

Pancreatic anastomosis training models:current status and future directions

Postoperative pancreatic fistula (POPF) is a major cause of morbidity and mortality after pancreatoduodenectomy (PD), and previous research has focused on patient-related risk factors and comparisons between anastomotic techniques. However, it is recognized that surgeon experience is an important factor in POPF outcomes, and that there is a significant learning curve for the pancreatic anastomosis. The aim of this study was to review the current literature on training models for the pancreatic anastomosis, and to explore areas for future research. It is concluded that research is needed to understand the mechanical properties of the human pancreas in an effort to develop a synthetic model that closely mimics its mechanical properties. Virtual reality (VR) is an attractive alternative to synthetic models for surgical training, and further work is needed to develop a VR pancreatic anastomosis training module that provides both high fidelity and haptic feedback

Threatened ecosystems of Myanmar. An IUCN Red List of ecosystems assessment. Version 1.0.

[Excerpt:] Myanmar's Red List of Ecosystems is a tool to understand our threats and plan for conservation and sustainable management. Forests constitute the dominant ecosystems in Myanmar, and we are blessed with high forest cover (42.92%) and diversity, with 36 of our 64 ecosystems identified as forest and mangrove. These forests and biodiversity underpin a range of ecosystem services which are central to Myanmar’s sustainable development, supporting human and resource needs, and contributing to a more stable climate. The loss of forests and our biodiversity leads to degradation and deterioration of ecosystem services and threatens Myanmar’s irreplaceable ecological heritage. We often discuss ecosystem services but this study documents Myanmar’s terrestrial ecosystem typology and spatial distribution for the first time. This is one of the first ecosystem red lists developed within ASEAN and this will inform our implementation for decades to come to inform legislation, land-use planning, protected area expansion, monitoring and reporting, and ecosystem management. To sustain our forests and our biodiversity we need to sustainably manage all of these incredible ecosystems

Effects of Nitrogen and Planting Seed Size on Cotton Growth, Development, and Yield

A standardized experiment was conducted during 2009 and 2010 at 20 location-years across U.S. cotton (Gossypium hirsutum L.)-producing states to compare the N use requirement of contemporary cotton cultivars based on their planting seed size. Treatments consisted of three cotton varieties with planting seed of different numbers of seed per kg and N rates of 0, 45, 90, and 134 kg ha⁻¹. Soil at each trial location was sampled and tested for nitrate presence. High levels of soil nitrate (>91 N-NO₃⁻kg ha⁻¹) were found in Arizona and western Texas, and soil nitrate in the range of 45 to 73 kg N-NO₃⁻ ha⁻¹ was found at locations in the central United States. Cotton lint yield responded to applied N at 11 of 20 locations. Considering only sites that responded to applied N, highest lint yields were achieved with 112 to 224 kg ha⁻¹of applied plus pre-plant residual soil NO₃—translating to an optimal N requirement of 23 kg ha⁻¹ per 218 kg bale of lint produced. Among the varieties tested those with medium-sized seed produced higher yields in response to N than did larger and smaller seeded varieties. Varieties with larger seed had longer and stronger fibers, higher fiber length uniformity than small seeded varieties and decreased micronaire. Seed protein and oil increased and decreased slightly in response to increasing amounts of soil nitrate plus applied N, respectively

The Politics, Power, and Pathologies of International Organizations.

Do international organizations really do what their creators intend them to do? In the past century the number of international organizations (1Os) has increased exponentially, and we have a variety of vigorous theories to explain why they have been created. Most of these theories explain IO creation as a response to problems of incomplete information, transaction costs, and other barriers to Pareto efficiency and welfare improvement for their members. Research flowing from these theories, however, has paid little attention to how IOs actually behave after they are created. Closer scrutiny would reveal that many IOs stray from the efficiency goals these theories impute and that many IOs exercise power autonomously in ways unintended and unanticipated by states at their creation. Understanding how this is so requires a reconsideration of IOs and what they do. In this article we develop a constructivist approach rooted in sociological institutionalism to explain both the power of IOs and their propensity for dysfunctional, even pathological, behavior. Drawing on long-standing Weberian arguments about bureaucracy and sociological institutionalist approaches to organizational behavior, we argue that the rational-legal authority that IOs embody gives them power independent of the states that created them and channels that power in particular directions. Bureaucracies, by definition, make rules, but in so doing they also create social knowledge. They define shared international tasks (like "development"), create and define new categories of actors (like "refugee"), create new interests for actors (like "promoting human rights"), and transfer models of political organization around the world (like markets and democracy.) However, the same normative valuation on impersonal, generalized rules that defines bureaucracies and makes them powerful in We are grateful t

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy