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Organisational scientists are paying increasing attention to humility, following a larger trend in scholarship highlighting the relational and interdependent nature of leadership and business. A growing body of evidence identifies humility as vital to effective organisational leadership, facilitating positive organisational outcomes, such as lower voluntary turnover and greater follower job satisfaction. To date, research on the subject has focused on certain specific organisational contexts, including businesses, hospitals, and schools. This paper reviews the existing literature and explores why humility may be an especially important leader trait in international humanitarian aid organisations and relief work-a context that is not only uniquely challenging, but also one that would seemingly stand to benefit keenly from the quality. It argues that humility is essential for effective leadership because it is normative of good character, it is predictive of positive outcomes, and it corresponds to a genuine representation of the nature of humanitarian aid.

OBJECTIVE. CT or MRI is most commonly used for characterizing focal hepatic lesions. However, findings on CT and MRI are occasionally indeterminate. Contrast-enhanced ultrasound (CEUS), with its unique characteristics as a purely intravascular contrast agent and real-time evaluation of enhancement, is a useful next step. The purpose of this article is to review the evidence for performing CEUS in the assessment of indeterminate hepatic lesions seen on CT and MRI. CONCLUSION. CEUS is a useful problem-solving tool in the evaluation of liver lesions that are indeterminate on CT and MRI. Uses include detection of arterial phase hyperenhancement; differentiation between hepatocellular carcinoma and intrahepatic cholangiocarcinoma; determination of benign versus malignant tumor thrombus, benign versus neoplastic cystic hepatic lesions, and hepatocellular adenoma versus focal nodular hyperplasia; and monitoring for recurrence in postablative therapies. CEUS can help establish a confident diagnosis and determine the need for further invasive diagnosis or treatment.

Prostate cancer is the most common cancer among men in the USA. A peptide derived from the active site of alpha-fetoprotein (AFP), known as AFPep, has been shown to be efficacious in inhibiting breast cancer growth. The role of this derived peptide AFPep in the development of prostate cancer has yet to be studied. To investigate the role of AFPep on prostate cancer, we used the PC-3 and DU-145 cell lines. We found that through key anti-apoptosis and pro-proliferation molecules, AFPep enhances the proliferation of DU-145 prostate cancer cells. The anti-proliferative molecules p18, p21, and p27, along with the pro-apoptotic molecules Fas and Bax, were all down-regulated in DU-145 cell lines treated with AFPep. Conversely, AFPep was not found to have a proliferative effect on the PC-3 prostate cancer cell line. This finding suggests the effects of AFPep to be cell line-specific in prostate cancer. Further investigation into the effects of AFPep could lead to new areas of treating prostate cancer.

Background Fibroids are present in at least 10% of pregnancies and are recognized to cause a variety of complications. A few case reports have described fibroids as an etiological factor in uterine rupture, sometimes with life-threatening hemorrhage. Case A 28-year-old G1, P0 woman at 20 weeks gestation developed systemic inflammatory response syndrome with acute renal failure and massive ascites secondary to a ruptured degenerated fibroid. This resulted in preterm delivery and neonatal death. At 6 weeks postpartum, she successfully underwent an abdominal myomectomy. Conclusion This is a rare case of uterine fibroid rupture causing preterm labour and systemic inflammatory response syndrome. This report discusses the diagnosis of uterine rupture related to the fibroid with imaging and subsequent management, which included fertility-preserving surgery.

This study explores how humility is contextualized in the culture of faith-based humanitarian aid leadership. Consensual Qualitative Research was used to synthesize the personal and observational experiences of 13 humanitarian aid leader exemplars. Characteristics and behaviors of humble leaders are discussed, along with the benefits of humble leadership on aid workers, local partners, and recipients of humanitarian aid services. A theistic dimension of humility is noted along with an outcome pathway for humble practice which considers barriers native to the humanitarian aid context.

Urinary diversions are surgical procedures that reconstruct the lower urinary tract following cystectomy. The 2 common surgical approaches are based on the continence status of the urinary tract. Incontinent diversions have continuous urine drainage through a cutaneous stoma, whereas continent diversions offer the patient the ability to self-void either via stoma catheterization or with the patient's own urethra. Given the large number of diversion procedures available, postsurgical anatomy may be complex. Multiple imaging modalities can be used to assess the postprocedural anatomy, potential complications, and for on-going oncologic monitoring. The purpose of this review is to describe the common surgical techniques and associated complications.

Critically ill patients with the Coronavirus disease 2019 (COVID-19) are dying in isolation without the comfort of their family or other social support in unprecedented numbers. Recently, healthcare teams at COVID-19 epicenters have been inundated with critically ill patients. Patients isolated for COVID-19 have had no contact with their family or loved ones and may have likely experienced death without closure. This situation highlights concerns about the psychological and spiritual well-being of patients with COVID-19 and their families, as they permanently part ways. While palliative care has advanced to address these patients' needs adequately, the COVID-19 pandemic presents several barriers that force healthcare teams to deprioritize these essential aspects of patient care. The severe acute respiratory syndrome (SARS) outbreak in 2003 gave us a glimpse of these challenges as these patients were also isolated in hospitals. Here, we discuss the importance of the biopsychosocial spiritual model in end-of-life care and its implications on patients dying with COVID-19. Furthermore, we outline an integrative approach to address the unique and holistic needs of critically ill patients dying with COVID-19. These include intentional and increased coordination with trained palliative care staff, early and frequent goals of care including discussion of end-of-life plans, broader use of technology to improve connectedness and shared decision making with patients’ families.

The purpose of this article is to review MRI technique, relevant anatomy, and MRI classification systems for the assessment of perianal fistulising disease. We present a stepwise approach to the assessment of perianal fistulas on MRI utilizing a systematic reporting format. MRI is invaluable for the assessment of perianal fistulas. A systematic report can help communicate the anatomy of complex fistulising disease to assist with optimal management.

Background Vocal fold movement impairment (VFMI) secondary to neuronal injury is a known risk after aortic surgery. Total arch replacement is technically challenging, and the incidence of vocal fold movement impairment secondary to neuronal injury after this surgery is unknown. This study examined the incidence of VFMI after total arch replacement and medialization treatment outcomes. Study design Retrospective cohort study. Methods All patients who underwent total arch replacement at a tertiary care center over 11 years (2006-2017) were identified through an institutional database. End points included evidence of VFMI on flexible laryngoscopy, time to diagnosis, time to treatment, need for reintubation, and intensive care unit (ICU) and hospital length of stay. Results Of the 358 patients who underwent total arch replacement, 63 (20%) were diagnosed with VFMI during their initial inpatient stay. Fifty patients (79%) VFMIs were left-sided, nine (14%) were right-sided, and four (6%) were bilateral. Thirty-nine patients (62%) underwent inpatient vocal fold medialization: 28 (72%) by injection laryngoplasty and 11 (28%) by type 1 thyroplasty. Those with unilateral VFMI had longer ICU (8.9 days) and hospital (19.4 days) than those with no VFMI (5.7 and 16.1 days). Among patients with unilateral VFMI, those who underwent inpatient vocal fold medialization trended toward shorter ICU (6.2 vs. 14.4 days, P = .03) and hospital stays (20.1 vs. 23.3 days, P = .4) than patients who did not have a medialization procedure. Conclusion The overall incidence of VFMI after total arch replacement in our series was 20%. Both the right and left vocal folds are potentially at risk from a total arch replacement; consequently, the distribution of injury in our cohort was more heterogeneous than in other series. Level of evidence 3 Laryngoscope, 129:699-703, 2019.

Significance Losing one copy of the RAI1 gene causes Smith–Magenis syndrome (SMS), a neurodevelopmental disorder. Using a newly generated SMS mouse model, this study demonstrates that restoring the Rai1 gene dose in an early postnatal window could repair gene expression and social interaction deficits in this SMS model. The SMS mouse model also showed a reduced density of dendritic spines, anatomical correlates of excitatory synapses, in the prefrontal cortex. Artificial activation of prefrontal cortex neurons partially alleviated the behavioral deficits. These findings suggest that, similar to Rett syndrome, SMS is caused by disruption of a chromatin-modifying gene with reversible developmental phenotypes, highlighting the potential treatment windows in childhood or adolescence., Haploinsufficiency of Retinoic Acid Induced 1 (RAI1) causes Smith–Magenis syndrome (SMS), a syndromic autism spectrum disorder associated with craniofacial abnormalities, intellectual disability, and behavioral problems. There is currently no cure for SMS. Here, we generated a genetic mouse model to determine the reversibility of SMS-like neurobehavioral phenotypes in Rai1 heterozygous mice. We show that normalizing the Rai1 level 3–4 wk after birth corrected the expression of genes related to neural developmental pathways and fully reversed a social interaction deficit caused by Rai1 haploinsufficiency. In contrast, Rai1 reactivation 7–8 wk after birth was not beneficial. We also demonstrated that the correct Rai1 dose is required in both excitatory and inhibitory neurons for proper social interactions. Finally, we found that Rai1 heterozygous mice exhibited a reduction of dendritic spines in the medial prefrontal cortex (mPFC) and that optogenetic activation of mPFC neurons in adults improved the social interaction deficit of Rai1 heterozygous mice. Together, these results suggest the existence of a postnatal temporal window during which restoring Rai1 can improve the transcriptional and social behavioral deficits in a mouse model of SMS. It is possible that circuit-level interventions would be beneficial beyond this critical window.

Beginning in 1983, the Journal of Psychology and Theology has published four special editions devoted to the topic of psychology and missions; on average, these issues were released at a rate of two per decade (i.e., 1983, 1987, 1993, and 1999). After a 17-year hiatus, this fifth psychology and missions special edition of JPT provides an opportunity to reflect on what we have learned thus far through the almost 70 articles published in JPT since 1973 on the interrelationship of psychological and theological concepts--all to the fulfillment of Christ's command to make disciples of all nations. To do so, we will follow Hall & Schram's (1999) outline in their introductory article to the fourth special edition; looking back to the past to consolidate gains, looking around to the present to note current trends, and looking forward to the future to identify gaps. Looking to the past: Consolidating gains Hall & Schram (1999) noted that since the early 1970s, the field of psychology had firmly established a place for itself in missions work, culminating in the creation of the new missionary discipline of member care, the leveraging of advancements in psychometrics on pre-field psychological assessments, and the promotion of a more robust understanding of the missionary family as a whole, with particular attention being given to missionary children. Indeed, these three gains noted by Hall & Schram back in 1999 continue to be influential to psychology practitioners and researchers involved in missions. Member Care. O'Donnell (1997), in his seminal article, "Member care in missions: Global perspectives and future directions," provided the now frequently referenced definition of the term member care: "Member care is the ongoing investment of resources by mission agencies, churches, and other mission organizations for the nurture and development of missionary personnel. It focuses on everyone in missions (missionaries, support staff, children, and families) and does so over the course of the missionary life-cycle, from recruitment through retirement" (p. 144). Concurrent with O'Donnell's work were the influential Reducing Missionary Attrition (ReMAP) studies (Taylor, 1997; Bloecher, 2005). Over the eight years between the ReMap I and the ReMAP II studies, the missionary attrition rate among New Sending Countries (e.g. Brazil, Ghana, Philippines, etc.) dropped by 50%; moreover, attrition rates in Older Sending Countries (e.g. Canada, Germany, U.S.A., etc.) remained low, in spite of global trends toward shorter appointments and frequent career changes (Bloecher, 2005). Bloecher (2005) in fact credited the contribution of on-field member care efforts and more comprehensive candidate selection procedures for these improvements in attrition rates. Many of the participants in the ReMAP studies who spoke of the effectiveness of member care efforts were mission agency leaders, rather than the missionaries themselves. To address this gap, Camp, Bustrum, Brokav, and Adams (2014) investigated the effectiveness of current member care practices specifically from the perspective of missionaries. This paper augmented O'Donnell's (1992, 2002, 2011) former depictions of member care by positing that effective member care involves a web of supportive and healthy relationships that facilitate fellowship and growth, consistent investment and support from sending and supporting churches, and personal investment in caring for oneself. As O'Donnell's classic definition of member care has guided much of the member care movement, we are excited to include O'Donnell and Lewis O'Donnell's (2016) latest work on the topic in this special issue, where they speak of member care workers as 'global integrators' who engage the world through multiple sectors. Pre-field psychological assessment. One key finding of ReMAP II (Bloecher, 2005) was the relationship between the thoroughness of an agency's selection procedure (i. …

Military sexual trauma (MST) encompasses experiences of sexual harassment and/or assault that occur during active duty military service. MST is associated with postdeployment mental health, interpersonal, and physical difficulties and appears to be more influential in the development of posttraumatic stress disorder (PTSD) than other active duty experiences, including combat, among women veterans. Although some literature suggests that men who experience MST also evidence significant postdeployment difficulties, research in this area is lacking. The current study evaluated a large sample of returning male veterans (N = 961) who served in Iraq and/or Afghanistan. Veterans were referred for treatment in a trauma and anxiety specialty clinic at a large VA hospital. Of this sample, 18% (n = 173) reported MST perpetrated by a member of their unit. Results indicated veterans who reported MST were younger (p = .001), less likely to be currently married (p < .001), more likely to be diagnosed with a mood disorder (p = .040), and more likely to have experienced non-MST sexual abuse either as children or adults (p < .001). Analyses revealed that MST was negatively associated with postdeployment social support (p < .001 and positively associated with postdeployment perceived emotional mistreatment (p = .004), but was not associated with postdeployment loss of romantic relationship (p = .264), job loss (p = .351), or unemployment (p = .741) after statistically controlling for other trauma exposures and current social support. Results reflect the detrimental associations of MST on male veterans and the need for more research in this area. These findings also highlight the need for treatment interventions that address social and interpersonal functioning in addition to symptoms of depressive disorders.

The growth plate, also known as the physis or epiphyseal plate, is essential for longitudinal growth of bones in the immature skeleton. A variety of insults to the growth plate from trauma to infection to idiopathic causes can lead to physeal bar formation, an interruption in normal growth plate cartilage, where a bony or fibrous bridge develops between the metaphysis and epiphysis. This bridge restricts subsequent bone growth, leading to limb shortening and/or angular deformities. Early recognition of the presence of a physeal bar can help direct appropriate surgical management to restore linear growth of the bone.

VT Ablation Through Internal Jugular Vein A retrograde approach to the left ventricle (LV) from the femoral artery is most commonly used for left ventricular tachycardia (VT) ablation. However, as the patient population gets older, the prevalence of peripheral vascular disease and aortic valve disease increases, hampering the retrograde access to the LV, which may result in significant technical difficulties. The transseptal approach from the femoral vein is an alternative access to the LV. This approach has been effective for addressing LV VT originating from the posterior and posteroseptal region. However, the transseptal approach from the femoral vein is impossible if there are any obstacles in the inferior vena cava. There are also significant limitations in approaching the basal-lateral region of the LV from this approach. We demonstrated the safety and feasibility of catheter ablation of LV VT via the transseptal approach from the right internal jugular vein. (J Cardiovasc Electrophysiol, Vol. 24, pp. 596–599, May 2013)

The Sonic Flashlight is an ultrasound (US) device that projects real-time US images into patients with use of a semireflective/transparent mirror. The present study evaluated the feasibility of use of the Sonic Flashlight for clinical peripherally inserted central catheter placements, originally with the mirror located inside a sterile cover (n = 15), then with the mirror outside (n = 11). Successful access was obtained in all cases. Results show that this new design improved visibility, as judged subjectively firsthand and in photographs. The study demonstrated the feasibility of the Sonic Flashlight and the new design to help assure sterility without degrading visibility, allowing further clinical trials involving physicians and nurses.

We describe a fully automated ultrasound analysis system that tracks and identifies the common carotid artery (CCA) and the internal jugular vein (IJV). Our goal is to prevent inadvertent damage to the CCA when targeting the IJV for catheterization. The automated system starts by identifying and fitting ellipses to all the regions that look like major arteries or veins throughout each B-mode ultrasound image frame. The Spokes Ellipse algorithm described in this paper tracks these putative vessels and calculates their characteristics, which are then weighted and summed to identify the vessels. The optimum subset of characteristics and their weights were determined from a training set of 38 subjects, whose necks were scanned with a portable 10 MHz ultrasound system at 10 fps. Stepwise linear discriminant analysis narrowed the characteristics to the five that best distinguish between the CCA and IJV. A paired version of Fisher's linear discriminant analysis was used to calculate the weights for each of the five parameters. Leave-one-out validation studies showed that the system could track and identify the CCA and IJV with 100% accuracy in this data set.

We describe a case series constituting the first clinical trial by intravenous (IV) team nurses using the sonic flashlight (SF) for ultrasound guidance of peripherally inserted central catheter (PICC) placement.Two IV team nurses with more than 10 years of experience with placing PICCs and 3 to 6 years of experience with ultrasound attempted to place PICCs under ultrasound guidance in patients requiring long-term IV access. One of two methods of ultrasound guidance was used: conventional ultrasound (CUS; 60 patients) or a new device called the SF (44 patients). The number of needle punctures required to gain IV access was recorded for each patient.In both methods, 87% of the cases resulted in successful venous access on the first attempt. The average number of needle sticks per patient was 1.18 for SF-guided procedures compared with 1.20 for CUS-guided procedures. No significant difference was found in the distribution of the number of attempts between the two methods. Anecdotal comments by the nurses indicated the comparative ease of use of the SF display, although the relatively small scale of the SF image compared with the CUS image was also noted.We have shown that the SF is a safe and effective device for guidance of PICC placement in the hands of experienced IV team nurses. The advantage of placing the ultrasound image at its actual location must be balanced against the relatively small scale of the SF image.

OBJECTIVE. The purpose of this article is to review the normal appearance of CSF, flow physics in relation to CSF flow dynamics, and commonly encountered appearances and artifacts of CSF due to superimposed flow effects.CONCLUSION. Normal CSF has inherent MRI properties of low signal intensity on T1-weighted sequences and high signal intensity on T2-weighted sequences. However, the normal CSF signal is frequently altered by superimposed flow phenomena that can confound interpretation.

The purpose of this study was to quantify and integrate key emergency department (ED) and radiology department workflow time intervals within the ED length of stay (LOS) for patients presenting with acute abdomen who require CT.An 11-month retrospective review was performed of all patients presenting to the ED with an acute abdomen who required abdominal CT. Nine key time points associated with ED LOS and CT workflow were collected: triage, physician assessment, CT request, porter schedule, CT start, CT complete, provision of first CT report, ED disposition decision, and physical discharge. The median and 90th percentile times for each interval were reported.Ninety-six percent (2194/2292) of ED encounters during the study period met the inclusion criteria. The median ED LOS was 9.22 hours (90th percentile, 15.7 hours). Intervals associated with CT workflow accounted for 29% of the total LOS. Radiology turnaround time accounted for 32% of the entire CT workflow interval. Timeline analysis found three unique patterns of ED disposition: disposition after initial imaging report, disposition before report, and disposition before CT.To our knowledge, this study is the first to quantify the contribution of CT-related workflow time intervals within the context of ED LOS. We have shown that patients do not have identical ED transit pathways, and this may under- or overestimate time interval calculations. These results show the importance of site-specific ED LOS timeline analysis to identify potential targets for quality improvement and serve as baseline targets for measuring future quality improvement initiatives.

Scaled teleoperation is increasingly prevalent in medicine, as well as in other applications of robotics. Visual feedback in such systems is essential and should make maximal use of natural hand-eye coordination. This paper describes a new method of visual feedback for scaled teleoperation in which the operator manipulates the handle of a remote tool in the presence of a registered virtual image of the target in real time. The method adapts a concept already used successfully in a new medical device called the Sonic Flashlight, which permits direct in situ visualization of ultrasound during invasive procedures. The Sonic Flashlight uses a flat-panel monitor and a half-silvered mirror to merge the visual outer surface of a patient with a simultaneous ultrasound scan of the patient's interior. Adapting the concept to scaled teleoperation involves removing the imaging device and the target to a remote location and adding a master-slave control device. This permits the operator to see his hands, along with what appears to be the tool, and the target, merged in a workspace that preserves natural hand-eye coordination. Three functioning prototypes are described, one based on ultrasound and two on light microscopy. The limitations and potential of the new approach are discussed.

This study evaluated reflex excitability and locomotor changes during chronic intrathecal infusion of the GABAb agonist baclofen (ITB) and its withdrawal, in the rat. We observed sustained velocity dependent decreases in ankle torque during four weeks of ITB treatment. These changes were correlated with a significant reduction of the EMG burst magnitude time locked to the dynamic phase of ankle dorsiflexion during the first ITB treatment week. However, a considerable recovery of EMG magnitude was observed during the third and fourth weeks of treatment. During baclofen withdrawal, significantly increased velocity dependent ankle torque was observed for 4 weeks. These increases in ankle torque were correlated with increased magnitudes of EMG time locked to the dynamic phase of ankle rotation. Measures of hind limb axis and base of support were obtained using analysis of footprints on a treadmill during ITB treatment and withdrawal periods. During ITB treatment and for up to 7 weeks of withdrawal, hindlimb axis and base of support were significantly altered compared with vehicle controls. These studies were performed to provide a foundation for evaluation of treatment and withdrawal in the setting of experimental chronic contusion spinal cord injury.

Background The expression of a novel cardiac glucose transporter, SGLT 1, is increased in glycogen storage cardiomyopathy secondary to mutations in PRKAG 2 . We sought to determine the role of SGLT 1 in the pathogenesis of PRKAG 2 cardiomyopathy and its role in cardiac structure and function. Methods and Results Transgenic mice with cardiomyocyte‐specific overexpression of human T400N mutant PRKAG2 cDNA (TG T400N ) and transgenic mice with cardiomyocyte‐specific RNA interference knockdown of SGLT1 (TG SGLT1‐DOWN ) were crossed to produce double‐transgenic mice (TG T400N /TG SGLT1‐DOWN ). Tet‐off transgenic mice conditionally overexpressing cardiac SGLT1 in the absence of doxycycline were also constructed (TG SGLT‐ON ). Relative to TG T400N mice, TG T400N /TG SGLT1‐DOWN mice exhibited decreases in cardiac SGLT1 expression (63% decrease, P T400N /TG SGLT1‐DOWN mice had less left ventricular dilation at age 12 weeks compared to TG T400N mice. Relative to wildtype (WT) mice, TG SGLT1‐ON mice exhibited increases in heart/body weight ratio, glycogen content, and markers of cardiac hypertrophy at ages 10 and 20 weeks. TG SGLT1‐ON mice had increased myocyte size and interstitial fibrosis, and progressive left ventricular dysfunction. When SGLT1 was suppressed after 10 weeks of overexpression (TG SGLT1‐ON/OFF ), there was a reduction in cardiac hypertrophy and improvement in left ventricular failure. Conclusions Cardiac knockdown of SGLT 1 in a murine model of PRKAG 2 cardiomyopathy attenuates the disease phenotype, implicating SGLT 1 in the pathogenesis. Overexpression of SGLT 1 causes pathologic cardiac hypertrophy and left ventricular failure that is reversible. This is the first report of cardiomyocyte‐specific transgenic knockdown of a target gene.

A variety of central nervous system injuries, diseases, and developmental deficits can lead to motor disorders that present complex mixtures of symptoms. Those that have a fundamental similarity characterized by the appearance of exaggerated velocity-dependent resistance to the lengthening of skeletal muscles are called spasticity. Reports based on clinical observations of motor disorders have and continue to provide the essential database of information regarding the range and distribution of unifying and discordant features of spasticity. Laboratory investigations employing animal models of motor disorders following experimental lesions of the central nervous system have reproduced some of the neurophysiologic changes that accompany injury of the central nervous system in humans. Those experimental lesions produced by spinal cord contusion/compression reproduce many of the histopathologic features displayed in traumatic injury of the human spinal cord as well. Studies using this model have revealed not only changes in reflex threshold and amplitude but also alterations in fundamental rate-modulation processes that regulate reflex excitability during repetitive stimulation. This report characterizes insights obtained from a laboratory investigation in search of fundamental mechanisms that contribute to the development of spasticity and provides a vantage point for understanding therapeutic strategies for treatment of spasticity. (J Child Neurol 2001;16:2-9).

Objective To determine the incidence of temporal lobe dysplasia (TLD) detected on prenatal ultrasound in thanatophoric dysplasia (TD) over an 11-year period in a tertiary referral center. Methods An 11-year retrospective review of perinatal autopsies from 2002 to 2013 was performed to identify cases of TD. The ultrasound images and corresponding reports of all TD cases were examined for the presence of TLD. The same set of images subsequently underwent a retrospective review by a perinatal radiologist with knowledge of the features of TLD to determine whether they could be identified. Results Thirty-one cases of TD underwent perinatal autopsy, and prenatal ultrasound imaging was available for review in 24 (77%). Mean gestational age at diagnosis of TD was 21.3 (range, 18-36) weeks. TLD was identified and reported in 6/24 (25%) cases; all six cases occurred after 2007. Retrospective interpretation of the ultrasound images identified features of TLD in 10 additional cases. In total, 16/24 (67%) cases displayed sonographic evidence of TLD. Temporal trends showed that TLD features were present in 50% (5/10) of all TD cases between 2002 and 2006 and in 79% (11/14) of those detected between 2007 and 2013. Conclusions At present, the detection rate of TLD by ultrasound is low but may be increased by modified brain images that enhance visualization of the temporal lobes. Prenatal identification of TLD may help in the prenatal diagnosis of TD and thus provide more accurate prenatal counseling and guide molecular investigations to confirm the specific diagnosis of TD.

We have derived and evaluated parameters from ultrasound images of the neck to permit a computer to automatically characterize and differentiate between the carotid artery and jugular vein at image acquisition time during vascular interventions, given manually placed seed points. Our goal is to prevent inadvertent damage to the carotid artery when targeting the jugular vein for catheterization. We used a portable 10 MHz ultrasound system to acquire cross sectional B-mode ultrasound images of these great vessels at 10 fps. An expert user identified the vessels in the first frame by touching the vessels on the screen with his fingertip, and the computer automatically tracked the vessels and calculated a best-fit ellipse for each vessel in each subsequent frame. Vessel location and radii were further analyzed to produce parameters that proved useful for differentiating between the carotid artery and jugular vein. These parameters include relative location of the vessels, distension of the vessel walls, and consistent phase difference between the arterial and venous pulsations as determined by temporal Fourier analysis.

We have extended the real-time tomographic reflection display of the Sonic Flashlight to a laser guidance system that aims to improve safety and accuracy of needle insertion, especially for deep procedures. This guidance system is fundamentally different from others currently available. Two low-intensity lasers are mounted on opposite sides of a needle aimed parallel to the needle. The needle is placed against a notch in the Sonic Flashlight mirror such that the laser beams reflect off the mirror to create bright red spots on the flat panel display. Due to diffuse reflection from these spots, the virtual image created by the flat panel display contains the spots, identifying the projected destination of the needle at its actual location in the tissue. We have implemented our design and validated its performance, identifying several areas for potential improvement.

We have developed a system architecture that will allow a surgeon to employ direct hand-eye coordination to conduct medical procedures in a remote microscopic environment. In this system, a scaled real-time video image of the workspace of a small robotic arm, taken from a surgical microscope camera, is visually superimposed on the natural workspace of a surgeon via a half-silvered mirror. The robot arm holds a small tool, such as a microsurgical needle holder or microsurgical forceps, and the surgeon grasps a second tool connected to a position encoder, in this case a second robot arm. The views of the local and remote environments are superimposed such that the tools in the local and remote environments are visually merged. The position encoder and small robot arm are linked such that movement of the tool by the operator produces scaled-down movement by the small robot tool. To the surgeon, it seems that his hands and the tool he or she is holding is moving and interacting with the remote environment, which is really microscopic and at a distance. Our current work focuses on using a position-controlled master-slave robot linkage of two 3 degree of freedom haptic devices, and we are pursuing the use of a 6-to-7 degree of freedom master-slave linkage to produce more realistic interaction.

A case in which a central poorly differentiated large cell bronchogenic carcinoma was incidentally detected in a 68-year-old woman with angina being evaluated with Tc- 99m SESTAMIBI myocardial perfusion analysis is reported.

A class of artificial intelligence (Al) programs known as neural networks are well suited to pattern recognition. A neural network is trained rather than programmed to recognize patterns. This differs from "expert system" Al programs in that it is not following an extensive set of rules determined by the programmer, but rather bases its decision on a gestalt interpretation of the image. The "bullseye" images from cardiac stress thallium tests performed on 50 male patients, as well as several simulated images were used to train the network. The network was able to accurately classify all patients in the training set. The network was then tested against 50 unknown patients and was able to correctly categorize 77% of the areas of ischemia and 92% of the areas of infarction. While not yet matching the ability of a trained physician, the neural network shows great promise in this area and has potential application in other areas of medical imaging.© (1991) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

A newly developed classification scheme for samples with discrete valued features is presented in this paper. In it, we first map the discrete feature space into a Euclidean space called logarithm of likelihood ratio (LLR) space. The likelihood ratios are formed from the estimated distributions based on the dependence tree structure obtained through minimizing the error probability. By discriminant analysis, we then transform the LLR space into one-dimensional space on which classification is conducted. We have applied this new scheme to several sets of biomedical data and have obtained significantly high classification rates.