Neighborhood and Depressive Symptoms in Older Adults Living in Rural and Urban Regions in South Korea.

Neighborhoods have a significant impact on depressive symptoms in older adults. In response to the increasing depression of older adults in Korea, this study aims to identify the relationship between perceived and objective neighborhood characteristics in depressive symptoms and find differences between rural and urban areas. We used a National survey collected in 2020 of 10,097 Korean older adults aged 65 and older. We also utilized Korean administration data for identifying the objective neighborhood characteristics. Multilevel modeling results indicated that depressive symptoms decreased when older adults perceived their housing condition (b = -0.04, p < 0.001), their interaction with neighbors (b = -0.02, p < 0.001), and overall neighborhood environment (b = -0.02, p < 0.001) positively. Among the objective neighborhood characteristics, only nursing homes (b = 0.09, p < 0.05) were related to depressive symptoms of older adults living in urban areas. For older adults living in rural areas, the number of social workers (b = -0.03, p < 0.001), the number of senior centers (b = -0.45, p < 0.001), and nursing home (b = -3.30, p < 0.001) in the neighborhood were negatively associated with depressive symptoms. This study found that rural and urban areas have different neighborhood characteristics related to older adults' depressive symptoms in South Korea. This study encourages policymakers to consider neighborhood characteristics to improve the mental health of older adults.

Adaptive Models for Multi-Covariate Imaging of Sub-Resolution Targets (MIST).

Multi-covariate imaging of sub-resolution targets (MIST) is a statistical, model-based image formation technique that smooths speckles and reduces clutter. MIST decomposes the measured covariance of the element signals into modeled contributions from mainlobe, sidelobes, and noise. MIST covariance models are derived from the well-known autocorrelation relationship between transmit apodization and backscatter covariance. During in vivo imaging, the effective transmit aperture often deviates from the applied apodization due to nonlinear propagation and wavefront aberration. Previously, the backscatter correlation length provided a first-order measure of these patient-specific effects. In this work, we generalize and extend this approach by developing data-adaptive covariance estimation, parameterization, and model-formation techniques. We performed MIST imaging using these adaptive models and evaluated the performance gains using 152 tissue-harmonic scans of fetal targets acquired from 15 healthy pregnant subjects. Compared to standard MIST imaging, the contrast-to-noise ratio (CNR) is improved by a median of 8.3%, and the speckle signal-to-noise ratio (SNR) is improved by a median of 9.7%. The median CNR and SNR gains over B-mode are improved from 29.4% to 40.4% and 24.7% to 38.3%, respectively. We present a versatile empirical function that can parameterize an arbitrary speckle covariance and estimate the effective coherent aperture size and higher order coherence loss. We studied the performance of the proposed methods as a function of input parameters. The implications of system-independent MIST implementation are discussed.

Intrinsic Tradeoffs in Multi-Covariate Imaging of Sub-Resolution Targets.

Multi-covariate Imaging of Sub-resolution Targets (MIST) is an estimation-based method of imaging the statistics of diffuse scattering targets. MIST estimates the contributions of a set of covariance models to the echo data covariance matrix. Models are defined based on a spatial decomposition of the theoretical transmit intensity distribution into ON-axis and OFF-axis contributions, delineated by a user-specified spatial cutoff. We define this cutoff as the region of interest width (ROI width). In our previous work, we selected the ROI width as the first zero crossing separating the mainlobe from the sidelobe regions. This article explores the effects of varying two key parameters on MIST image quality: 1) ROI width and 2) the degree of spatial averaging of the measured echo data covariance matrix. These results demonstrate a fundamental tradeoff between resolution and speckle texture. We characterize MIST imaging performance across these tunable parameters in a number of simulated, phantom, and in vivo liver applications. We consider performance in noise, fidelity to native contrast, resolution, and speckle texture. MIST is also compared with varying levels of spatial and frequency compounding, demonstrating quantitative improvements in image quality at comparable levels of speckle reduction. In an in vivo example, optimized MIST images demonstrated 20.2% and 13.4% improvements in contrast-to-noise ratio over optimized spatial and frequency compounding images, respectively. These results present a framework for selecting MIST parameters to maximize speckle signal-to-noise ratio without an appreciable loss in resolution.

Synthetic Aperture Focusing for Multi-Covariate Imaging of Sub-Resolution Targets.

Coherence-based imaging methods suffer from reduced image quality outside the depth of field for focused ultrasound transmissions. Synthetic aperture methods can extend the depth of field by coherently compounding time-delayed echo data from multiple transmit events. Recently, our group has presented the Multi-covariate Imaging of Sub-resolution Targets (MIST), an estimation-based method to image the statistical properties of diffuse targets. MIST has demonstrated improved image quality over conventional delay-and-sum, but like many coherence-based imaging methods, suffers from limited depth of field artifacts. This article applies synthetic aperture focusing to MIST, which is evaluated using focused, plane-wave, and diverging-wave transmit geometries. Synthetic aperture MIST is evaluated in simulation, phantom, and in vivo applications, demonstrating consistent improvements in contrast-to-noise ratio (CNR) over conventional dynamic receive MIST outside the transmit depth of field, with approximately equivalent results between synthetic transmit geometries. In vivo synthetic aperture MIST images demonstrated 16.8 dB and 16.6% improvements in contrast and CNR, respectively, over dynamic receive MIST images, as well as 17.4 dB and 32.3% improvements over synthetic aperture B-Mode. MIST performance is characterized in the space of plane-wave imaging, where the total plane-wave count is reduced through coarse angular sampling or total angular span. Simulation and experimental results indicate wide applicability of MIST to synthetic aperture imaging methods.

Speckle coherence of piecewise-stationary stochastic targets.

The van Cittert-Zernike (VCZ) theorem describes the propagation of spatial covariance from an incoherent source distribution, such as backscatter from stochastic targets in pulse-echo imaging. These stochastic targets are typically assumed statistically stationary and spatially incoherent with uniform scattering strength. In this work, the VCZ theorem is applied to a piecewise-stationary scattering model. Under this framework, the spatial covariance of the received echo data is demonstrated as the linear superposition of covariances from distinct spatial regions. This theory is analytically derived from fundamental physical principles, and validated through simulation studies demonstrating superposition and scaling. Simulations show that linearity is preserved over various depths and transmit apodizations, and in the presence of noise. These results provide a general framework to decompose spatial covariance into contributions from distinct regions of interest, which may be applied to advanced imaging methods. While the simulation tools used for validation are specific to ultrasound, this analysis is generally applicable to other coherent imaging applications involving stochastic targets. This covariance decomposition provides the physical basis for a recently described imaging method, Multi-covariate Imaging of Sub-resolution Targets.

Multi-covariate Imaging of Sub-resolution Targets.

Conventional B-mode ultrasound imaging assumes that targets consist of collections of point scatterers. Diffraction, however, presents a fundamental limit on a scanner's ability to resolve individual scatterers in most clinical imaging environments. Well-known optics and ultrasound literature has characterized these diffuse scattering targets as spatially incoherent and statistically stationary. In this paper, we apply a piecewise-stationary statistical model to diffuse scattering targets, in which the covariance of backscattered echoes can be described as the linear superposition of constituent components corresponding to echoes from distinct spatial regions in the field. Using this framework, we present Multi-covariate Imaging of Sub-resolution Targets (MIST), a novel estimation-based method to image the statistical properties of diffuse scattering targets, based on a decomposition of aperture domain spatial covariance. The mathematical foundations of the estimator are analytically derived, and MIST is evaluated in phantom, simulation, and in vivo studies, demonstrating consistent improvements in contrast-to-noise ratio and speckle statistics across imaging targets, without an apparent loss in resolution.

Short-lag Spatial Coherence Imaging in 1.5-D and 1.75-D Arrays: Elevation Performance and Array Design Considerations.

Short-lag spatial coherence (SLSC) imaging has demonstrated improved performance over conventional B-Mode ultrasound imaging. Previous work has evaluated the performance of SLSC using 2-D matrix arrays in simulation and in vivo studies across various levels of subaperture beamforming, demonstrating improved contrast-to-noise ratio (CNR) and speckle signal-to-noise ratio (SNR) over 1-D arrays. This work explores the application of SLSC imaging in 1.5-D and 1.75-D arrays to quantify the impacts of elevation element count, mirroring, and Fresnel element spacing on SLSC image quality. Through simulation and in vivo studies, increased elevation element count was shown to improve CNR and speckle SNR relative to 1-D SLSC and B-Mode images. Elevation mirroring (1.5-D) was shown to force the inclusion of long lags into the SLSC calculation, introducing additional decorrelation and reducing image quality relative to 1.75-D arrays with individually-connected elements. These results demonstrate the effectiveness of SLSC imaging in 1.5-D and 1.75-D arrays.

Versatile Low-Cost Volumetric 3-D Ultrasound Platform for Existing Clinical 2-D Systems.

Ultrasound imaging has indications across many areas of medicine, but the need for training and the variability in skill and acquired image quality among 2-D ultrasound users have limited its wider adoption and utilization. Low-cost volumetric ultrasound with a known frame of reference has the potential to lower these operator-dependent barriers and enhance the clinical utility of ultrasound imaging. In this paper, we improve upon our previous research-scanner-based prototype to implement a versatile volumetric imaging platform for existing clinical 2-D ultrasound systems. We present improved data acquisition and image reconstruction schemes to increase quality, streamline workflow, and provide real-time visual feedback. We present initial results using the platform on a Vimedix simulator, as well as on phantom and in vivo targets using a variety of clinical ultrasound systems and probes.

Low-cost Volumetric Ultrasound by Augmentation of 2D Systems: Design and Prototype.

Conventional two-dimensional (2D) ultrasound imaging is a powerful diagnostic tool in the hands of an experienced user, yet 2D ultrasound remains clinically underutilized and inherently incomplete, with output being very operator dependent. Volumetric ultrasound systems can more fully capture a three-dimensional (3D) region of interest, but current 3D systems require specialized transducers, are prohibitively expensive for many clinical departments, and do not register image orientation with respect to the patient; these systems are designed to provide improved workflow rather than operator independence. This work investigates whether it is possible to add volumetric 3D imaging capability to existing 2D ultrasound systems at minimal cost, providing a practical means of reducing operator dependence in ultrasound. In this paper, we present a low-cost method to make 2D ultrasound systems capable of quality volumetric image acquisition: we present the general system design and image acquisition method, including the use of a probe-mounted orientation sensor, a simple probe fixture prototype, and an offline volume reconstruction technique. We demonstrate initial results of the method, implemented using a Verasonics Vantage research scanner.

Chronic intrauterine pulmonary hypertension increases main pulmonary artery stiffness and adventitial remodeling in fetal sheep.

Persistent pulmonary hypertension of the newborn (PPHN) is a clinical syndrome that is characterized by high pulmonary vascular resistance due to changes in lung vascular growth, structure, and tone. PPHN has been primarily considered as a disease of the small pulmonary arteries (PA), but proximal vascular stiffness has been shown to be an important predictor of morbidity and mortality in other diseases associated with pulmonary hypertension (PH). The objective of this study is to characterize main PA (MPA) stiffness in experimental PPHN and to determine the relationship of altered biomechanics of the MPA with changes in extracellular matrix (ECM) content and orientation of collagen and elastin fibers. MPAs were isolated from control and PPHN fetal sheep model and were tested by planar biaxial testing to measure stiffness in circumferential and axial vessel orientations. Test specimens were fixed for histological assessments of the vascular wall ECM constituents collagen and elastin. MPAs from PPHN sheep had increased mechanical stiffness (P < 0.05) and altered ECM remodeling compared with control MPA. A constitutive mathematical model and histology demonstrated that PPHN vessels have a smaller contribution of elastin and a greater role for collagen fiber engagement compared with the control arteries. We conclude that exposure to chronic hemodynamic stress in late-gestation fetal sheep increases proximal PA stiffness and alters ECM remodeling. We speculate that proximal PA stiffness further contributes to increased right ventricular impedance in experimental PPHN, which contributes to abnormal transition of the pulmonary circulation at birth.

Phosphorus removal in a surface-flow constructed wetland treating agricultural runoff.

Agricultural runoff is a leading source of phosphorus (P) pollution to lakes and streams. The objective of this study was to evaluate P removal dynamics in a constructed treatment wetland (CTW) treating agricultural irrigation return flows. The CTW included a sedimentation basin (SB) followed by two surface-flow wetlands in parallel. Typical retention times and total P (TP) loading were 1.4 d and 50 to 110 g m yr P, respectively, for the SB and 5 to 6 d and 4 to 10 g m yr P, respectively, for wetlands. On the basis of this multiyear study, concentration removal efficiency in the SB averaged 21% for TP and 32% for reactive phosphorus (RP). Concentration removal efficiency in wetlands averaged 37 and 43% for TP and 22 and 33% for RP. Areal first-order removal rates for TP averaged 22 and 31 m yr in wetlands. Total P removal in wetlands exhibited a strong seasonal pattern, with minimum removal in the summer when high temperatures likely enhanced P release from decaying plant biomass. The performance of the CTW was stochastic, with removal unpredictably poorer in some years in part as a result of muskrat bioturbation and plant harvesting. In years before muskrat impacts, concentration removal efficiencies in wetlands were 50% for TP and 65% for RP.