Clinical workflow of sonographers performing fetal anomaly ultrasound scans: deep-learning-based analysis.

OBJECTIVE: Despite decades of obstetric scanning, the field of sonographer workflow remains largely unexplored. In the second trimester, sonographers use scan guidelines to guide their acquisition of standard planes and structures; however, the scan-acquisition order is not prescribed. Using deep-learning-based video analysis, the aim of this study was to develop a deeper understanding of the clinical workflow undertaken by sonographers during second-trimester anomaly scans. METHODS: We collected prospectively full-length video recordings of routine second-trimester anomaly scans. Important scan events in the videos were identified by detecting automatically image freeze and image/clip save. The video immediately preceding and following the important event was extracted and labeled as one of 11 commonly acquired anatomical structures. We developed and used a purposely trained and tested deep-learning annotation model to label automatically the large number of scan events. Thus, anomaly scans were partitioned as a sequence of anatomical planes or fetal structures obtained over time. RESULTS: A total of 496 anomaly scans performed by 14 sonographers were available for analysis. UK guidelines specify that an image or videoclip of five different anatomical regions must be stored and these were detected in the majority of scans: head/brain was detected in 97.2% of scans, coronal face view (nose/lips) in 86.1%, abdomen in 93.1%, spine in 95.0% and femur in 92.3%. Analyzing the clinical workflow, we observed that sonographers were most likely to begin their scan by capturing the head/brain (in 24.4% of scans), spine (in 23.2%) or thorax/heart (in 22.8%). The most commonly identified two-structure transitions were: placenta/amniotic fluid to maternal anatomy, occurring in 44.5% of scans; head/brain to coronal face (nose/lips) in 42.7%; abdomen to thorax/heart in 26.1%; and three-dimensional/four-dimensional face to sagittal face (profile) in 23.7%. Transitions between three or more consecutive structures in sequence were uncommon (up to 13% of scans). None of the captured anomaly scans shared an entirely identical sequence. CONCLUSIONS: We present a novel evaluation of the anomaly scan acquisition process using a deep-learning-based analysis of ultrasound video. We note wide variation in the number and sequence of structures obtained during routine second-trimester anomaly scans. Overall, each anomaly scan was found to be unique in its scanning sequence, suggesting that sonographers take advantage of the fetal position and acquire the standard planes according to their visibility rather than following a strict acquisition order. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Expected-value bias in routine third-trimester growth scans.

OBJECTIVES: Operators performing fetal growth scans are usually aware of the gestational age of the pregnancy, which may lead to expected-value bias when performing biometric measurements. We aimed to evaluate the incidence of expected-value bias in routine fetal growth scans and assess its impact on standard biometric measurements. METHODS: We collected prospectively full-length video recordings of routine ultrasound growth scans coupled with operator eye tracking. Expected value was defined as the gestational age at the time of the scan, based on the estimated due date that was established at the dating scan. Expected-value bias was defined as occurring when the operator looked at the measurement box on the screen during the process of caliper adjustment before saving a measurement. We studied the three standard biometric planes on which measurements of head circumference (HC), abdominal circumference (AC) and femur length (FL) are obtained. We evaluated the incidence of expected-value bias and quantified the impact of biased measurements. RESULTS: We analyzed 272 third-trimester growth scans, performed by 16 operators, during which a total of 1409 measurements (354 HC, 703 AC and 352 FL; including repeat measurements) were obtained. Expected-value bias occurred in 91.4% of the saved standard biometric plane measurements (85.0% for HC, 92.9% for AC and 94.9% for FL). The operators were more likely to adjust the measurements towards the expected value than away from it (47.7% vs 19.7% of measurements; P < 0.001). On average, measurements were corrected by 2.3 ± 5.6, 2.4 ± 10.4 and 3.2 ± 10.4 days of gestation towards the expected gestational age for the HC, AC, and FL measurements, respectively. Additionally, we noted a statistically significant reduction in measurement variance once the operator was biased (P = 0.026). Comparing the lowest and highest possible estimated fetal weight (using the smallest and largest biased HC, AC and FL measurements), we noted that the discordance, in percentage terms, was 10.1% ± 6.5%, and that in 17% (95% CI, 12-21%) of the scans, the fetus could be considered as small-for-gestational age or appropriate-for-gestational age if using the smallest or largest possible measurements, respectively. Similarly, in 13% (95% CI, 9-16%) of scans, the fetus could be considered as large-for-gestational age or appropriate-for-gestational age if using the largest or smallest possible measurements, respectively. CONCLUSIONS: During routine third-trimester growth scans, expected-value bias frequently occurs and significantly changes standard biometric measurements obtained. © 2019 the Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Using AnnAGNPS to Predict the Effects of Tile Drainage Control on Nutrient and Sediment Loads for a River Basin.

Controlled tile drainage (CTD) can reduce pollutant loading. The Annualized Agricultural Nonpoint Source model (AnnAGNPS version 5.2) was used to examine changes in growing season discharge, sediment, nitrogen, and phosphorus loads due to CTD for a ∼3900-km agriculturally dominated river basin in Ontario, Canada. Two tile drain depth scenarios were examined in detail to mimic tile drainage control for flat cropland: 600 mm depth (CTD) and 200 mm (CTD) depth below surface. Summed for five growing seasons (CTD), direct runoff, total N, and dissolved N were reduced by 6.6, 3.5, and 13.7%, respectively. However, five seasons of summed total P, dissolved P, and total suspended solid loads increased as a result of CTD by 0.96, 1.6, and 0.23%. The AnnAGNPS results were compared with mass fluxes observed from paired experimental watersheds (250, 470 ha) in the river basin. The "test" experimental watershed was dominated by CTD and the "reference" watershed by free drainage. Notwithstanding environmental/land use differences between the watersheds and basin, comparisons of seasonal observed and predicted discharge reductions were comparable in 100% of respective cases. Nutrient load comparisons were more consistent for dissolved, relative to particulate water quality endpoints. For one season under corn crop production, AnnAGNPS predicted a 55% decrease (CTD) in dissolved N from the basin. AnnAGNPS v. 5.2 treats P transport from a surface pool perspective, which is appropriate for many systems. However, for assessment of tile drainage management practices for relatively flat tile-dominated systems, AnnAGNPS may benefit from consideration of P and particulate transport in the subsurface.

Sorption of microconstituents onto primary sludge.

The presence of microconstituents (MCs) in the environment has become an emerging concern to scientists and engineers. Sorption is one of the important removal mechanisms for MCs in wastewater treatment plants (WWTPs) since there is significant sludge production. The purpose of this study is to explore sorption kinetics and isotherms of MCs onto primary sludge. Three MCs, bisphenol-A (BPA), 17-α-ethinylestradiol (EE2) and triclosan (TCS), were chosen for this study. They are hydrophobic and have low vapor pressure, which makes sorption a potential removal mechanism. Both sorption kinetics and isotherm experiments were conducted using primary sludge collected from a local municipal WWTP. The time to equilibrium was around 7 h for all chosen MCs. A pseudo second-order rate model was better at describing the sorption rate than a pseudo first-order rate model. Linear sorption isotherm models were found to fit the experimental data, and the solid-liquid partitioning coefficients for BPA, EE2 and TCS were 81, 728 and 6,407 L/kg.

Comprehensive review and compilation of pretreatments for mesophilic and thermophilic anaerobic digestion.

Organic matter hydrolysis prior to anaerobic digestion has been shown to improve biogas production (30-50%) and reduce solids (20-60%) by ultrasound, chemical, conventional heating, and microwave pretreatments. Numerous studies have been performed to determine the extent of digestion improvement but few focus on financial feasibility of these processes. A comprehensive model was created using Microsoft Excel and its Visual Basic Assistant to evaluate pretreatment permutations for conventional wastewater treatment plants. The four above-mentioned processes were evaluated for energetic and financial demands. Well-established energy equations and wastewater characteristics, both average and high, were used. Average and high flows were 460 and 750×10(3) m3/d, respectively. Net costs per influent flow for ultrasound, chemical, conventional heating, and microwave were 0.0166, 0.0217, 0.0124, 0.0119 $/m3 and 0.0264, 0.0357, 0.0187, and 0.0162 $/m3 for average and high conditions, respectively. The average cost increase from results excluding pretreatment use for all processes was 0.003 and 0.0055 $/m3 for average and high conditions, respectively. No matter the permutation, pretreatments requiring more energy to achieve required hydrolysis levels were costlier. If energetic recoveries are substantial, dewaterability is positively affected, and solids meet environmental constraints to be handled and disposed at lower costs, pretreatments can be viable.

Discovering Salient Anatomical Landmarks by Predicting Human Gaze.

Anatomical landmarks are a crucial prerequisite for many medical imaging tasks. Usually, the set of landmarks for a given task is predefined by experts. The landmark locations for a given image are then annotated manually or via machine learning methods trained on manual annotations. In this paper, in contrast, we present a method to automatically discover and localize anatomical landmarks in medical images. Specifically, we consider landmarks that attract the visual attention of humans, which we term visually salient landmarks. We illustrate the method for fetal neurosonographic images. First, full-length clinical fetal ultrasound scans are recorded with live sonographer gaze-tracking. Next, a convolutional neural network (CNN) is trained to predict the gaze point distribution (saliency map) of the sonographers on scan video frames. The CNN is then used to predict saliency maps of unseen fetal neurosonographic images, and the landmarks are extracted as the local maxima of these saliency maps. Finally, the landmarks are matched across images by clustering the landmark CNN features. We show that the discovered landmarks can be used within affine image registration, with average landmark alignment errors between 4.1% and 10.9% of the fetal head long axis length.

An objective test of stochastic behavior in riverine water quality models.

Predictions of river water quality models are subject to substantial uncertainties, which depend not only on parameterization and calibration strategies but also on the structure of the conceptual model itself. To evaluate the importance of this effect and associated implications for stochastic models, investigations were conducted based on a segment of the Potomac River in the eastern USA. Two commonly used conceptual representations of real-world processes were used, and their simulation of DO, BOD and NH(4) components scrutinized. A GLUE approach to the inverse problem was then used to examine how uncertainty changed along the river network for each conceptual model. Differences were observed not only between deterministic instances of each conceptual model, but also between their response surfaces as a whole. Uncertainties within the river network are substantially influenced by the selection of calibration data used, as well as the primary source of the constituent examined. The suggested methodology can be used to test conceptual model validity for specific applications. The results of this study will help users select and assess models for varied problems, and refine appropriate data collection and monitoring schemes.

Spatio-Temporal Partitioning and Description of Full-Length Routine Fetal Anomaly Ultrasound Scans.

This paper considers automatic clinical workflow description of full-length routine fetal anomaly ultrasound scans using deep learning approaches for spatio-temporal video analysis. Multiple architectures consisting of 2D and 2D + t CNN, LSTM, and convolutional LSTM are investigated and compared. The contributions of short-term and long-term temporal changes are studied, and a multi-stream framework analysis is found to achieve the best top-1 accuracy=0.77 and top-3 accuracy=0.94. Automated partitioning and characterisation on unlabelled full-length video scans show high correlation (ρ=0.95, p=0.0004) with workflow statistics of manually labelled videos, suggesting practicality of proposed methods.

Initial examination of microwave pretreatment on primary, secondary and mixed sludges before and after anaerobic digestion.

The effects of microwave pretreatment on disintegration and mesophilic digestion of waste activated sludge (WAS), primary sludge (PS), combined (PS + WAS) sequencing batch reactor (SBR) sludge and anaerobically digested biocake were investigated by both household and bench scale industrial types microwaves at temperatures below and above boiling point. Pretreatment variables, temperature, intensity (cooking rate) and sludge concentration had statistically significant effects on solubilization. The microwave pretreatment also increased the bioavailability of sludge components under batch anaerobic digestion and enhanced the dewaterability of pretreated sludges after digestion. However, the level of improvements in solubilization and biodegradation from different waste sludges were different. While the largest improvement in ultimate biodegradation was observed in WAS, microwave irradiation only affected the rate of biodegradation of pretreated PS samples. Similarly, relatively lower solubilization ratios achieved for combined - SBR sludge was attributed to high sludge age of extended aeration SBR unit. It is possible that initial sludge characteristics may influence final pretreatment outcomes so that general statements of performance cannot always be made.

[Cybernetic studies of the behavior of human equilibrium using frequency analysis (2)]. / Kybernetische Untersuchungen zum menschlichen Gleichgewichtsregelverhalten mittels Frequenzanalyse (Teil 2).

The present paper describes the evaluation of static and dynamic experiments investigating the regulation of human balance. The results from a neurologically unremarkable group of test subjects are reported and discussed. These results are compared with those of a patient suffering from multi-infarction disease.

Assessment of physiological state of microorganisms in activated sludge with flow cytometry: application for monitoring sludge production minimization.

Many sludge reduction processes have been studied for the minimization of sludge production in biological wastewater treatment. The investigations on most of these processes have monitored the increase of the soluble chemical oxygen demand, the sludge mass reduction, or the decrease of the floc size, but little information has been obtained on cell lysis and the change of the biological cell activity. However, employing any strategy for reducing sludge production may have an impact of microbial community in biological wastewater treatment process. This impact may influence the sludge characteristics and the quality of effluent. The objective of this study concerns the determination of the physiological state of activated sludge microorganisms during a sludge minimization process. A thermal treatment at 80 degrees C for 5, 20, 40 and 60 min was chosen in this study. Staining bacteria with CTC and SYTOX green was used to evaluate biological cell activity and viability of cell types contained in activated sludge, respectively. The monitoring of cell activity and viability was performed using flow cytometry (FCM) analysis before and after thermal treatment of activated sludge. Results indicated an increase in the number of permeabilized cells and a decrease in the number of active cells, subsequent to the thermal treatment. The study also confirms the potential of FCM to successfully evaluate the physiological heterogeneity of an activated sludge bacterial population. Moreover, the experimentally observed correlations between the FCM results and the organic matter solubilization in activated sludge samples during thermal treatment revealed that the increase in the soluble organic matter concentration was predominantly due to an intracellular material release. Identifying the increase in activated sludge hydrolysis requires a precise knowledge of the involved mechanisms, and this study indicated that the FCM, used in conjunction with specific probes, could be a useful tool.

Modeling active mass in aerobic sludge digestion.

Aerobic digestion of waste-activated sludge was carried out in lab-scale reactors for both batch and semicontinuous flow patterns. The reactors were monitored at three different temperatures: 10, 20, and 30 degrees C. During the course of digestion, significant solubilization of volatile suspended solids was observed, and its effect on the magnitude of kinetic coefficients was examined. Differences in metabolic activity and sludge stabilization were found between batch and semicontinuous flow patterns. An Arrhenius-type relationship was not found to apply to rate constants for the semicontinuous reactors.

Sequential substrate utilization and effectiveness factor in fixed biofilms.

A mathematical model describing the change in effectiveness factor or effective diffusivity for the intermediate substrate in sequential substrate removal reactions in fixed biofilms is developed. Typical results from the numerical solution of the resulting equation are presented. The production of intermediate substrate in the biofilm increases the conversion of primary substrate to ultimate product in all cases, but the increase is not always significant. Using typical data applying to laboratory anaerobic fermentation studies, it is demonstrated that a small but significant change in reaction kinetics and the effectiveness factor exists.

Startup of anaerobic downflow stationary fixed film (DSFF) reactors.

One of the serious problems limiting the application of full-scale anaerobic fixed film processes is reactor startup. To better understand startup, studies with downflow stationary fixed film (DSFF) reactors were conducted to characterize the effects of influent concentration, support material, and surface-to-volume ratio on biofilm development and overall reactor performance. Materials with roughened surfaces gave the best startup performance and as expected increased surface area in the reactors led to more rapid increases in loading rates and higher ultimate loadings. Soluble influent COD concentrations between 5 x 10(3) and 2 x 10(4) mg/L influenced the rate of biofilm development. Lower COD concentrations resulted in faster development of the biofilm, even though ultimate loadings were not necessarily achieved as rapidly as in reactors fed higher strength wastes. No decrease in specific activity of the biofilms in each reactor was observed as the thickness of the biofilms increased to their maximum value at the ultimate loadings. The operation of reactors fed lower strength wastes was more stable than reactors receiving higher strength feeds at comparable loadings. Biofilm yield and activity, COD removals, suspended growth and activity, and other system parameters are discussed.

Review of Expert System (ES), Geographic Information System (GIS), Decision Support System (DSS), and their applications in landfill design and management.

This paper provides the reader with a brief discussion on Expert System (ES), Geographic Information System (GIS), and Environmental Decision Support System (EDSS) technologies and their applications in environmental engineering in general and in landfill design and management in specific. It also brings into attention the benefits of integrating ESs and GISs together with simulation models (SM) in a decision support systems (DSS) framework to solve complex environmental problems, facilitated by the new advancements of computer technologies (both in hardware and software). Examples of such integration are provided to reflect how such a system can improve landfill design and management. Finally, the discussion concludes with the fact that although solving landfill design problems could greatly benefit from such a combination of technologies, there have been no attempts to combine ES, GIS, and SM for the comprehensive evaluation of landfill design and performance.

Desmin is a specific marker for rhabdomyosarcomas of human and rat origin.

Putative human rhabdomyosarcoma (RMS) has been divided into two groups according to desmin content. Twenty-five tumors with histologic features consistent with but not necessarily sufficient to prove a diagnosis of RMS were desmin-positive. More than 95% of the tumor cells were desmin-positive, suggesting a muscle origin and supporting the diagnosis of RMS. Nine tumors for which the preferred first histologic diagnosis was also RMS were desmin-negative. Reexamination of the original histologic slides together with results from intermediate filament typing resulted in a diagnosis other than RMS for all tumors in this second group, and in several instances other tests were used to prove the correctness of the final diagnosis. The results on human material were extended to a rat model system in which RMS was induced by nickel sulfide. Again, all 24 tumors tested were desmin-positive. Vimentin was coexpressed in a varying percentage of tumor cells in RMS of human and rat origin. The results show that desmin is an excellent marker for rhabdomyosarcoma, yielding few if any false-positive or false-negative results in frozen or alcohol-fixed material.

[2 cases of primary sclerosing cholangitis--the ERCP documentation of a 3-year course of immunosuppressive therapy]. / Zwei Fälle einer primär sklerosierenden Cholangitis--ERCP-Dokumentation eines 3-jährigen Verlaufs unter immunsuppressiver Therapie.

X-ray characteristics of two cases of primary sclerosing cholangitis are described. A discussion of clinical, immunological and histological features of the disease and the 3-years progress of a 40 year old man during treatment with immunesuppressive therapy (Imurek at the beginning with cortison) is shown. The stop of the progression of the disease is supposed.

[Multi-axial system of chapter V (F) of ICD-10. Initial results of a multicenter practicability and reliability study]. / Multiaxiales System des Kapitels V (F) der ICD-10. Erste Ergebnisse der multizentrischen Praktikabilitäts-und Reliabilitätsstudie.

With the introduction of operationalized diagnostic systems the multiaxial approach became a more important issue. The proposed multiaxial system of ICD-10 consists of three axes: on axis I psychiatric diagnoses are made according to the ICD-10 Clinical Guidelines or Diagnostic Criteria for Research. Axis II (Disability Diagnostic Scale, DDS) deals with impairment of psychosocial functioning. On axis III environmental/circumstantial and personal lifestyle management factors are rated. As part of the WHO international field trial, applicability and inter-rater reliability of the system were examined in seven German-speaking centers. In addition axis II was compared with the corresponding axis of DSM-III-R (Global Assessment of Functioning Scale). 45 German clinicians rated 12 case histories written in English (provided by WHO) with 488 ratings altogether. Diagnoses on axis I with an average percentage agreement of 65.6% and a mean kappa of 0.50 showed a moderate inter-rater reliability. For axis II the intraclass coefficient was 0.62, and that for the corresponding DSM-III axis was 0.65: both these axes thus also had a moderate inter-rater reliability. There was a close correlation between the subscales and the global assessment of axis II there was. Wide variation was found in the psychosocial circumstances on axis III, the mean kappa value being 0.16. In the discussion proposals for the revision process for the multiaxial ICD-10 system are made.