Three-dimensional geometric image analysis for interventional electrophysiology

Improving imaging hardware, computational power, and algorithmic design are driving advances in interventional medical imaging. We lay the groundwork here for more effective use of machine learning and image registration in clinical electrophysiology. To achieve identification of atrial fibrosis using image data, we registered the electroanatomic map (EAM) data of atrial fibrillation (AF) patients undergoing pulmonary vein isolation (PVI) with MR (n = 16) or CT (n = 18) images. The relationship between image features and bipolar voltage was evaluated using single-parameter regression and random forest models. Random forest performed significantly better than regression, identifying fibrosis with area under the receiver operating characteristic curve (AUC) 0.746 (MR) and 0.977 (CT). This is the first evaluation of voltage prediction using image data. Next, we compared the character of native atrial fibrosis with ablation scar in MR images. Fourteen AF patients undergoing repeat PVI were recruited. EAM data from their first PVI was registered to the MR images acquired before the first PVI (‘pre-operative’) and before the second PVI ('post-operative' with respect to the first PVI). Non-ablation map points had similar characteristics in the two images, while ablation points exhibited higher intensity and more heterogeneity in post-operative images. Ablation scar is more strongly enhancing and more heterogeneous than native fibrosis. Finally, we addressed myocardial measurement in 3-D echocardiograms. The circular Hough transform was modified with a feature asymmetry filter, epicardial edges, and a search constraint. Manual and Hough measurements were compared in 5641 slices from 3-D images. The enhanced Hough algorithm was more accurate than the unmodified version (Dice coefficient 0.77 vs. 0.58). This method promises utility in segmentation-assisted cross-modality registration. By improving the information that can be extracted from medical images and the ease with which that information can be accessed, this progress will contribute to the advancing integration of imaging in electrophysiology.</p

Three-dimensional geometric image analysis for interventional electrophysiology

Improving imaging hardware, computational power, and algorithmic design are driving advances in interventional medical imaging. We lay the groundwork here for more effective use of machine learning and image registration in clinical electrophysiology. To achieve identification of atrial fibrosis using image data, we registered the electroanatomic map (EAM) data of atrial fibrillation (AF) patients undergoing pulmonary vein isolation (PVI) with MR (n = 16) or CT (n = 18) images. The relationship between image features and bipolar voltage was evaluated using single-parameter regression and random forest models. Random forest performed significantly better than regression, identifying fibrosis with area under the receiver operating characteristic curve (AUC) 0.746 (MR) and 0.977 (CT). This is the first evaluation of voltage prediction using image data. Next, we compared the character of native atrial fibrosis with ablation scar in MR images. Fourteen AF patients undergoing repeat PVI were recruited. EAM data from their first PVI was registered to the MR images acquired before the first PVI (‘pre-operative’) and before the second PVI ('post-operative' with respect to the first PVI). Non-ablation map points had similar characteristics in the two images, while ablation points exhibited higher intensity and more heterogeneity in post-operative images. Ablation scar is more strongly enhancing and more heterogeneous than native fibrosis. Finally, we addressed myocardial measurement in 3-D echocardiograms. The circular Hough transform was modified with a feature asymmetry filter, epicardial edges, and a search constraint. Manual and Hough measurements were compared in 5641 slices from 3-D images. The enhanced Hough algorithm was more accurate than the unmodified version (Dice coefficient 0.77 vs. 0.58). This method promises utility in segmentation-assisted cross-modality registration. By improving the information that can be extracted from medical images and the ease with which that information can be accessed, this progress will contribute to the advancing integration of imaging in electrophysiology.This thesis is not currently available on ORA

Career accomplishments of uniformed services university of the health sciences medical graduates: Classes 1980–2001

© Association of Military Surgeons of the U.S. All rights reserved. Purpose: To report accomplishments of graduates of the F. Edward Hébert School of Medicine who have left, retired, or are near the end of their uniformed career in several professional domains: military career milestones, medical professional education, academic landmarks, and leadership. Methods: This study utilized an earlier questionnaire that was modified to capture additional career landmarks and improve the clarity of several items. The modified survey was sent electronically to alumni who graduated from 1980–2001 in March, 2012. Results: The questionnaire was sent to 2,825 alumni for whom we had e-mail addresses. We estimate that we reached 2,400 alumni. A total of 1,189 alumni returned the questionnaire, yielding an estimated response rate of 50%. For this cohort, the board certification was 95%, over 20% obtained additional degrees, 92.8% had worked as a full-time physician, nearly two-thirds had deployed for combat, 13.9% had received the Legion of Merit, and 68.6% had published at least one peer-reviewed manuscript. Conclusion: Many accomplishments including board certification rates, deployment experience, academic and military leadership positions, military awards, promotion rates, and academic medicine contributions are indicators that USU is continuing to meet its unique mission

Assessing curriculum effectiveness: A survey of uniformed services university medical school graduates

© Association of Military Surgeons of the U.S. All rights reserved. Purpose: This study assessed alumni perceptions of their preparedness for clinical practice using the Accreditation Council for Graduate Medical Education (ACGME) competencies. We hypothesized that our alumni’s perception of preparedness would be highest for military-unique practice and professionalism and lowest for system-based practice and practice-based learning and improvement. Method: 1,189 alumni who graduated from the Uniformed Services University (USU) between 1980 and 2001 completed a survey modeled to assess the ACGME competencies on a 5-point, Likert-type scale. Specifically, self-reports of competencies related to patient care, communication and interpersonal skills, medical knowledge, professionalism, systems-based practice, practice-based learning and improvement, and militaryunique practice were evaluated. Results: Consistent with our expectations as the nation’s military medical school, our graduates were most confident in their preparedness for military-unique practice, which included items assessing military leadership (M = 4.30, SD = 0.65). USU graduates also indicated being well prepared for the challenges of residency education in the domain of professionalism (M = 4.02, SD = 0.72). Self-reports were also high for competencies related to patient care (M = 3.86, SD = 0.68), communication and interpersonal skills (M = 3.88, SD = 0.66), and medical knowledge (M = 3.78, SD = 0.73). Consistent with expectations, systems-based practice (M = 3.50, SD = 0.70) and practice-based learning and improvement (M = 3.57, SD = 0.62) were the lowest rated competencies, although self-reported preparedness was still quite high. Discussion: Our findings suggest that, from the perspective of our graduates, USU is providing both an effective military-unique curriculum and is preparing trainees for residency training. Further, these results support the notion that graduates are prepared to lead and to practice medicine in austere environments. Compared to other competencies that were assessed, self-ratings for systems-based practice and practice-based learning and improvement were the lowest, which suggests the need to continue to improve USU education in these areas

Identifying themes within a medical school admission committee\u27s reviews of applicants

Background: Admissions committees attempt to select the most qualified applicants based on many cognitive and noncognitive factors. Purpose: Identify common themes cited in the admissions committee member summaries of medical school matriculants and determine the relative frequency and importance of these themes. Methods: After reviewing a convenience sample of 150 reviewer comments, 14 qualitative themes were identified. Utterances (thematic word strings) from each of the three reviewer comments for each matriculant for 7 academic years (1989-1996) were then categorized and coded as being positive, negative, or neutral. Intra-rater and inter-rater reliabilities were calculated. Results: Utterances (n = 9299) about 981 matriculants were categorized by theme and sorted as being positive, neutral, or negative. Intra-rater reliabilities were excellent (mean K = 0.98, range 0.90-1.00). Similarly, inter-rater reliabilities were also excellent (mean K = 0.94, range 0.55-1.00 and mean K = 0.90, range 0.08-1.00). Four themes (overall summarizing comments, academic, test scores, and motivation) accounted for more than half (56%) of the utterances. Conclusions: We were able to qualitatively identify themes and provide information about how one committee weighs both cognitive and noncognitive factors. Admission committees should consider reexamining their process and potentially expanding, eliminating, or modifying application components. © Association of Military Surgeons of the U.S. All rights reserved

Relationship between admissions committee review and student performance in medical school and internship

Purpose: To investigate the association between tertiary reviewer (admissions committee member) comments and medical students\u27 performance during medical school and into internship. Methods: We collected data from seven year-groups (1993-1999) and coded tertiary reviewer comments into 14 themes. We then conducted an exploratory factor analysis to reduce the dimensions of the themes (excluding the Overall impression theme). Subsequently, we performed Pearson correlation analyses and multiple linear regression analysis to examine the relationship between the factors and seven outcome measures: medical school preclinical grade point average (GPA), medical school clinical GPA, cumulative medical school GPA, U.S. Medical Licensing Examination Step 1 and 2 scores, and scores on a program director\u27s evaluation measuring intern professionalism and expertise. Results: We extracted seven factors from the 13 themes and found small-to-moderate, significant correlations between the factors, the Overall impression theme, and the outcome measures. In particular, positive comments on Test and Maturity were associated with higher U.S. Medical Licensing Examination Step 1 and 2 scores. Negative comments on Interview and Recommendations were associated with lower ratings of professionalism during internship. Comments on Overall impression were significantly associated with all the outcome measures. Conclusions: Tertiary reviewer comments were weakly associated with performance in medical school and internship. Compared with positive comments, negative comments had stronger associations with medical school and internship performance measures. © Association of Military Surgeons of the U.S. All rights reserved

The Long-Term Career Outcome Study (LTCOS): What have we learned from 40 years of military medical education and where should we go?

The work of the Long-Term Career Outcome Study (LTCOS), F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USU) has been a multidisciplinary effort spanning more than 5 years. Borrowing from the established program evaluation and quality assurance literature, the LTCOS team has organized its evaluation and research efforts into three phases: before medical school, during medical school, and after medical school. The purpose of this commentary is to summarize the research articles presented in this special issue and to answer two fundamental questions: (1) what has been learned from LTCOS research conducted to date, and (2) where should the LTCOS team take its evaluation and research efforts in the future? Answers to these questions are relevant to USU, and they also can inform other medical education institutions and policy makers. What is more, answers to these questions will help to ensure USU meets its societal obligation to provide the highest quality health care to military members, their families, and society at large. © Association of Military Surgeons of the U.S. All rights reserved

Where are they now? USU School of Medicine graduates after their military obligation is complete

The Uniformed Services University\u27s (USU) F. Edward Hébert School of Medicine was chartered in 1972, with the goal of providing high-quality physicians for the Uniformed Services. In exchange for their education, USU graduates incur an active duty service obligation, after which they may choose to stay on active duty or transition to civilian practice. The purpose of this study is to describe the practice characteristics of USU graduates after this obligation has been completed in order to determine the societal benefits during this phase of their careers. To accomplish this purpose, we performed a retrospective cohort study of the first 20 years of USU graduates (1980-1999). We used the American Medical Association Physician Masterfile to determine the graduates\u27 current practice location and characteristics, as well as their board certification status. Of these 2,760 graduates, nearly all (91%) were involved in active clinical practice in over 100 self-declared specialties, the vast majority (89%) practiced in locations other than the immediate vicinity of the medical school (i.e., Maryland and the District of Columbia), and most still worked for the federal government (71%). Finally, USU graduates in full-time clinical practice had a board certification rate of 93%, which was better than the average of all other graduates of U.S. Medical Schools (88%) in the same time period. Thus, it seems USU is attaining its goal of producing high-quality physicians who continue to benefit the nation after their service obligation has been completed, with many still in federal service. © Association of Military Surgeons of the U.S. All rights reserved

40 years of military medical education: An overview of the Long-Term Career Outcome Study (LTCOS)

In 2005, the Long-Term Career Outcome Study (LTCOS) was established by the Dean, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USU). The original charge to the LTCOS team was to establish an electronic database of current and past students at USU. Since its inception, however, the LTCOS team has broadened its mission and started collecting and analyzing data on a continuous basis for the purposes of program evaluation and, in some cases, research. The purpose of this commentary is to review the history of the LTCOS, including details about USU, a brief review of prior LTCOS work, and progress made since our last essay on LTCOS efforts. This commentary also provides an introduction to the special issue, which is arranged as a series of articles that span the medical education continuum (i.e., before, during, and after medical school). The relative balance of articles in each phase of training represents the LTCOS team\u27s efforts to address the entire continuum of medical education

Leadership success and the Uniformed Services University: Perspectives of flag officer alumni

The Uniformed Services University of the Health Sciences (USU) houses the nation\u27s only federal medical school, the F. Edward Hébert School of Medicine. A key aspect of the curriculum at USU is leadership education as graduates go on to serve the Department of Defense through a variety of senior positions in the military. We surveyed a specific group of USU graduates who have achieved the rank of General or Admiral ( flag officers ) to enhance our understanding of successful leadership for military physicians and to gain an understanding of how USU might shape its curriculum in the future. Methods: We sent an Internet-based survey to 13 flag officer graduates. The first section of the survey contained items from the multifactor leadership questionnaire-6S, a questionnaire with evidence of reliability and validity for evaluating leadership styles. The second section of the survey contained openended questions addressing key characteristics of an effective leader in the Military Health System, experiences that prepared them for leadership, USU\u27s role in leadership positions, and advice for USU for better educating future leaders. The second section of the survey was coded using the constant comparative method. Results: Eight flag officers (63%) responded to the survey. They all scored highly on transformational leadership style. Qualitative themes reached saturation for each open-ended question. The flag officers identified characteristics consistent with published literature from other fields regarding effective leadership. They endorsed USU\u27s role in achieving their leadership positions and suggested areas for improvement. Conclusions: Characteristics of effective leadership (transformational leadership style) identified by the flag officers surveyed in this study are consistent with the literature from other fields. These finding have important implications for leadership education at USU and potentially other institutions. The results also provide additional data to support the notion that USU is meeting its societal obligation to educate future leaders in military medicine. © Association of Military Surgeons of the U.S. All rights reserved