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Abstract Manual delineation of liver segments on computed tomography (CT) images for primary/secondary liver cancer (LC) patients is time-intensive and prone to inter/intra-observer variability. Therefore, we developed a deep-learning-based model to auto-contour liver segments and spleen on contrast-enhanced CT (CECT) images. We trained two models using 3d patch-based attention U-Net ( $${{\text{M}}}_{{\text{paU}}-{\text{Net}}})$$ M paU - Net ) and 3d full resolution of nnU-Net ( $${{\text{M}}}_{{\text{nnU}}-{\text{Net}}})$$ M nnU - Net ) to determine the best architecture ( $${\text{BA}})$$ BA ) . BA was used with vessels ( $${{\text{M}}}_{{\text{Vess}}})$$ M Vess ) and spleen ( $${{\text{M}}}_{{\text{seg}}+{\text{spleen}}})$$ M seg + spleen ) to assess the impact on segment contouring. Models were trained, validated, and tested on 160 ( $${{\text{C}}}_{{\text{RTTrain}}}$$ C RTTrain ), 40 ( $${{\text{C}}}_{{\text{RTVal}}}$$ C RTVal ), 33 ( $${{\text{C}}}_{{\text{LS}}}$$ C LS ), 25 (CCH) and 20 (CPVE) CECT of LC patients. $${{\text{M}}}_{{\text{nnU}}-{\text{Net}}}$$ M nnU - Net outperformed $${{\text{M}}}_{{\text{paU}}-{\text{Net}}}$$ M paU - Net across all segments with median differences in Dice similarity coefficients (DSC) ranging 0.03–0.05 (p 0.05), however, both were slightly better than $${{\text{M}}}_{{\text{Vess}}}$$ M Vess by DSC up to 0.02. The final model, $${{\text{M}}}_{{\text{seg}}+{\text{spleen}}}$$ M seg + spleen , showed a mean DSC of 0.89, 0.82, 0.88, 0.87, 0.96, and 0.95 for segments 1, 2, 3, 4, 5–8, and spleen, respectively on entire test sets. Qualitatively, more than 85% of cases showed a Likert score $$\ge$$ ≥ 3 on test sets. Our final model provides clinically acceptable contours of liver segments and spleen which are usable in treatment planning.

Cerebrovascular reactivity (CVR) is a prognostic indicator of cerebrovascular health. Estimating CVR from endogenous end-tidal carbon dioxide (CO2) fluctuation and MRI signal recorded under resting state can be difficult due to the poor signal-to-noise ratio (SNR) of signals. Thus, we aimed to improve the method of estimating CVR from end-tidal CO2 and MRI signals. We proposed a coherence weighted general linear model (CW-GLM) to estimate CVR from the Fourier coefficients weighted by the signal coherence in frequency domain, which confers two advantages. First, it requires no signal alignment in time domain, which simplifies experimental methods. Second, it limits the GLM analysis within the frequency band where CO2 and MRI signals are highly correlated, which automatically suppresses noise and nuisance signals. We compared the performance of our method with time-domain GLM (TD-GLM) and frequency-domain GLM (FD-GLM) in both synthetic and in-vivo data; wherein we calculated CVR from signals recorded under both resting state and sinusoidal stimulus. In synthetic data, CW-GLM has a remarkable performance on CVR estimation from narrow band signals with a mean-absolute error of 0.7 % (gray matter) and 1.2 % (white matter), which was lower than all the other methods. Meanwhile, CW-GLM maintains a comparable performance on CVR estimation from resting signals, with a mean-absolute error of 4.1 % (gray matter) and 8 % (white matter). The superior performance was maintained across the 36 in-vivo measurements, with CW-GLM exhibiting limits of agreement of -16.7 % – 9.5 % between CVR calculated from the resting and sinusoidal CO2 paradigms which was 12 % – 209 % better than current time-domain methods. Evaluating of the cross-coherence spectrum revealed highest signal coherence within the frequency band from 0.01 Hz to 0.05 Hz, which overlaps with previously recommended frequency band (0.02 Hz to 0.04 Hz) for CVR analysis. Our data demonstrates that CW-GLM can work as a self-adaptive band-pass filter to improve CVR robustness, while also avoiding the need for signal temporal alignment.

Underwater archaeological excavations present unique challenges, particularly when conducted at significant depths where divers face limited time on the archaeological site. Traditional methods of recording excavation progress, such as manual documentation and drawings, are too time-consuming when the time on the site totals no more than 12 min. To address these limitations, this paper introduces an innovative approach for daily recording and observation of underwater archaeological excavations using 3D photogrammetric models and point of view (PoV) cameras developed specifically for the excavation of a shipwreck situated at a depth of 110 m. The proposed system leverages advancements in photogrammetry and 3D modelling techniques to capture and analyse detailed visual data of the excavation site on a daily basis. Three-dimensional photogrammetric models offer a comprehensive and easily accessible representation of the excavation site, enabling the team to record and analyse excavation levels and features in a highly precise and detailed manner. By comparing the 3D models captured on consecutive days, researchers can precisely measure changes in the excavation area, identify new artifacts or structures, and record the progress of the excavation. The PoV cameras contribute to the planning of daily tasks required on the site. Overall, this paper showcases innovative methods for underwater archaeological excavations at significant depths, employing 3D photogrammetric models for daily recording as well as PoV cameras for observation. The proposed system represents a substantial advancement in the field of underwater archaeology, offering a more accurate, efficient, and reliable approach to documenting and analysing excavation progress, whilst also producing results that can be subsequently adapted and applied to other deep water archaeological sites.

Background: An unplanned hospital admission of a nursing home resident distresses the person, their family and nursing home staff, and is costly to the NHS. Improving health care in care homes, including early detection of residents’ health changes, may reduce hospital admissions. Previously, we identified four conditions associated with avoidable hospital admissions. We noted promising ‘within-home’ complex interventions including care pathways, knowledge and skills enhancement, and implementation support. Objectives: Develop a complex intervention with implementation support [the Better Health in Residents in Care Homes with Nursing (BHiRCH-NH)] to improve early detection, assessment and treatment for the four conditions. Determine its impact on hospital admissions, test study procedures and acceptability of the intervention and implementation support, and indicate if a definitive trial was warranted. Design: A Carer Reference Panel advised on the intervention, implementation support and study documentation, and engaged in data analysis and interpretation. In workstream 1, we developed a complex intervention to reduce rates of hospitalisation from nursing homes using mixed methods, including a rapid research review, semistructured interviews and consensus workshops. The complex intervention comprised care pathways, approaches to enhance staff knowledge and skills, implementation support and clarity regarding the role of family carers. In workstream 2, we tested the complex intervention and implementation support via two work packages. In work package 1, we conducted a feasibility study of the intervention, implementation support and study procedures in two nursing homes and refined the complex intervention to comprise the Stop and Watch Early Warning Tool (S&W), condition-specific care pathways and a structured framework for nurses to communicate with primary care. The final implementation support included identifying two Practice Development Champions (PDCs) in each intervention home, and supporting them with a training workshop, practice development support group, monthly coaching calls, handbooks and web-based resources. In work package 2, we undertook a cluster randomised controlled trial to pilot test the complex intervention for acceptability and a preliminary estimate of effect. Setting: Fourteen nursing homes allocated to intervention and implementation support (n = 7) or treatment as usual (n = 7). Participants: We recruited sufficient numbers of nursing homes (n = 14), staff (n = 148), family carers (n = 95) and residents (n = 245). Two nursing homes withdrew prior to the intervention starting. Intervention: This ran from February to July 2018. Data sources: Individual-level data on nursing home residents, their family carers and staff; system-level data using nursing home records; and process-level data comprising how the intervention was implemented. Data were collected on recruitment rates, consent and the numbers of family carers who wished to be involved in the residents’ care. Completeness of outcome measures and data collection and the return rate of questionnaires were assessed. Results: The pilot trial showed no effects on hospitalisations or secondary outcomes. No home implemented the intervention tools as expected. Most staff endorsed the importance of early detection, assessment and treatment. Many reported that they ‘were already doing it’, using an early-warning tool; a detailed nursing assessment; or the situation, background, assessment, recommendation communication protocol. Three homes never used the S&W and four never used care pathways. Only 16 S&W forms and eight care pathways were completed. Care records revealed little use of the intervention principles. PDCs from five of six intervention homes attended the training workshop, following which they had variable engagement with implementation support. Progression criteria regarding recruitment and data collection were met: 70% of homes were retained, the proportion of missing data was

Introduction In the UK, a compulsory ‘6-week hip check’ is performed in primary care for the detection of developmental dysplasia of the hip (DDH). However, missed diagnoses and infants incorrectly labelled with DDH remain a problem, potentially leading to adverse consequences for infants, their families and the National Health Service. National policy states that infants should be referred to hospital if the 6-week check suggests DDH, though there is no available tool to aid examination or offer guidelines for referral. We developed standardised diagnostic criteria for DDH, based on international Delphi consensus, and a 9-item checklist that has the potential to enable non-experts to diagnose DDH in a manner approaching that of experts.Methods and analysis We will conduct a controlled trial randomised by practice that will compare a diagnostic aid against standard care for the hip check. The primary objective is to determine whether an aid to the diagnosis of DDH reduces the number of clinically insignificant referrals from primary care to hospital and the number of late diagnosed DDH. The trial will include a qualitative process evaluation, an assessment of professional behavioural change and a full health economic evaluation. We will recruit 152 general practitioner practices in England. These will be randomised to conduct the hip checks with use of the study diagnostic aid and/or as per usual practice. The total number of infants seen during a 15-month recruitment period will be 110 per practice. Two years after the 6-week hip check, we will measure the number of referred infants that are (1) clinically insignificant for DDH and (2) those that constitute appropriate referrals.Ethics and dissemination This study has approval from the Health Research Authority (16/1/2020) and the Confidentiality Advisory Group (18/2/2020). Results will be published in peer-reviewed academic journals, disseminated to patient organisations and the media.Trial registration number NCT04101903; Pre-results.

In situ hyperspectral remote-sensing reflectance (Rrs(λ)) is used to derive water quality products and perform autonomous monitoring of aquatic ecosystems. Conventionally, above-water Rrs(λ) is estimated from three spectroradiometers which measure downwelling planar irradiance (Ed(λ)), sky radiance (Ls(λ)), and total upwelling radiance (Lt(λ)), with a scaling of Ls(λ)/Ed(λ) used to correct for surface-reflected radiance. Here, we incorporate direct and diffuse irradiance, (Edd(λ)) and Eds(λ)), from a hyperspectral pyranometer (HSP) in an Rrs(λ) processing algorithm from a solar-tracking radiometry platform (So-Rad). HSP measurements of sun and sky glint (scaled Edd(λ)/Ed(λ) and Eds(λ)/Ed(λ)) replace model-optimized terms in the 3C (three-glint component) Rrs(λ) algorithm, which estimates Rrs(λ) via spectral optimization of modelled atmospheric and water properties with respect to measured radiometric quantities. We refer to the HSP-enabled method as DD (direct-diffuse) and compare differences in Rrs(λ) and Rrs(λ) variability (assessed over 20 min measurement cycles) between 3C and DD as a function of atmospheric optical state using data from three ports in the Western Channel. The greatest divergence between the algorithms occurs in the blue part of the spectrum where DD has significantly lower Rrs(λ) variability than 3C in clearer sky conditions. We also consider Rrs(λ) processing from a hypothetical two-sensor configuration (using only the Lt(λ) spectroradiometer and the HSP and referred to as DD2) as a potential lower-cost measurement solution, which is shown to have comparable Rrs(λ) and Rrs(λ) variability to DD in clearer sky conditions. Our results support that the HSP sensor can fulfil a dual role in aquatic ecosystem monitoring by improving precision in Rrs(λ) alongside its primary function to characterize aerosols.

Abstract Background Heart failure related to cardiac siderosis remains a major cause of death in transfusion dependent anaemias. Replacement fibrosis has been reported as causative of heart failure in siderotic cardiomyopathy in historical reports, but these findings do not accord with the reversible nature of siderotic heart failure achievable with intensive iron chelation. Methods Ten whole human hearts (9 beta-thalassemia major, 1 sideroblastic anaemia) were examined for iron loading and fibrosis (replacement and interstitial). Five had died from heart failure, 4 had cardiac transplantation for heart failure, and 1 had no heart failure (death from a stroke). Heart samples iron content was measured using atomic emission spectroscopy. Interstitial fibrosis was quantified by computer using picrosirius red (PSR) staining and expressed as collagen volume fraction (CVF) with normal value for left ventricle

Background: With a prevalence of up to 16.5%, depression is one of the commonest mental disorders in people with advanced cancer. Depression reduces the quality of life (QoL) of patients and those close to them. The National Institute for Health and Care Excellence (NICE) guidelines recommend treating depression using antidepressants and/or psychological treatments, such as cognitive–behavioural therapy (CBT). Although CBT has been shown to be effective for people with cancer, it is unclear whether or not this is the case for people with advanced cancer and depression. Objectives: To assess the clinical effectiveness and cost-effectiveness of treatment as usual (TAU) plus manualised CBT, delivered by high-level Improving Access to Psychological Therapy (IAPT) practitioners, versus TAU for people with advanced cancer and depression, measured at baseline, 6, 12, 18 and 24 weeks. Design: Parallel-group, single-blind, randomised trial, stratified by whether or not an antidepressant was prescribed, comparing TAU with CBT plus TAU. Setting: Recruitment took place in oncology, hospice and primary care settings. CBT was delivered in IAPT centres or/and over the telephone. Participants: Patients (N = 230; n = 115 in each arm) with advanced cancer and depression. Inclusion criteria were a diagnosis of cancer not amenable to cure, a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnosis of depressive disorder using the Mini-International Neuropsychiatric Interview, a sufficient understanding of English and eligibility for treatment in an IAPT centre. Exclusion criteria were an estimated survival of

The seabed can be considered as the world’s largest museum, and underwater sites explored and studied so far provide priceless information on human interaction with the sea. In recognition of the importance of this cultural resource, UNESCO, in its 2001 Convention on the Protection of the Underwater Cultural Heritage, determined that objects/sites should be preserved in situ, whilst also advocating for public access and sharing. The implementation of these principles is not without difficulties. Some states have opened up underwater sites to the public—mainly through diving, yet the vast majority of the world’s population does not dive. In Malta, 7000 years of human occupation is reflected in and on the landscape, and recent offshore surveys show that the islands’ long and complex history has also left an indelible mark on the seabed. Besides difficulties related to their protection and management, these sites also present a challenge with regard to sharing and communicating. Recent advances in underwater imaging and processing software have accelerated the development of 3D photogrammetry of submerged sites and the idea for a virtual museum was born. The virtual museum, UnderwaterMalta, was created out of a need to share the plethora of underwater sites located on the seabed of the Maltese Islands. A multitude of digital tools are used to share and communicate these sites, offering visitors a dry dive into submerged sites that would otherwise remain invisible to the vast majority of the public. This paper discusses the basic principle of the sharing of underwater cultural heritage and the difficulties that beset the implementation of such a principle. A detailed explanation and evaluation of the methods used to gather the raw data needed is set in the context of the particular and unique working conditions related to deep water sites. The workings of this paper are based on first-hand experiences garnered through the recording of numerous wrecks over the years and the creation and launch of The Virtual Museum-Underwater Malta—a comprehensive virtual museum specifically built for “displaying” underwater archaeological sites that are otherwise invisible to the general public.

Legislatures have banned CRT across many states in America, altering the country's campus climate. This case study surveys more than 200 students, faculty, and staff on campus to understand their points of view on CRT. The authors find a "pernicious polarization" dividing the university and suggest that university faculty consider a "Critical Patriotic Civic History" to provide a multi-perspectival pedagogy to prepare our multicultural student body to become our country's next generation of citizens.

Background: Mild frailty or pre-frailty is common and yet is potentially reversible. Preventing progression to worsening frailty may benefit individuals and lower health/social care costs. However, we know little about effective approaches to preventing frailty progression. Objectives: (1) To develop an evidence- and theory-based home-based health promotion intervention for older people with mild frailty. (2) To assess feasibility, costs and acceptability of (i) the intervention and (ii) a full-scale clinical effectiveness and cost-effectiveness randomised controlled trial (RCT). Design: Evidence reviews, qualitative studies, intervention development and a feasibility RCT with process evaluation. Intervention development: Two systematic reviews (including systematic searches of 14 databases and registries, 1990–2016 and 1980–2014), a state-of-the-art review (from inception to 2015) and policy review identified effective components for our intervention. We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people (aged 65–94 years) (n = 44), carers (n = 12) and health/social care professionals (n = 27). These data, and our evidence reviews, fed into development of the ‘HomeHealth’ intervention in collaboration with older people and multidisciplinary stakeholders. ‘HomeHealth’ comprised 3–6 sessions with a support worker trained in behaviour change techniques, communication skills, exercise, nutrition and mood. Participants addressed self-directed independence and well-being goals, supported through education, skills training, enabling individuals to overcome barriers, providing feedback, maximising motivation and promoting habit formation. Feasibility RCT: Single-blind RCT, individually randomised to ‘HomeHealth’ or treatment as usual (TAU). Setting: Community settings in London and Hertfordshire, UK. Participants: A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty. Main outcome measures: Feasibility – recruitment, retention, acceptability and intervention costs. Clinical and health economic outcome data at 6 months included functioning, frailty status, well-being, psychological distress, quality of life, capability and NHS and societal service utilisation/costs. Results: We successfully recruited to target, with good 6-month retention (94%). Trial procedures were acceptable with minimal missing data. Individual randomisation was feasible. The intervention was acceptable, with good fidelity and modest delivery costs (£307 per patient). A total of 96% of participants identified at least one goal, which were mostly exercise related (73%). We found significantly better functioning (Barthel Index +1.68; p = 0.004), better grip strength (+6.48 kg; p = 0.02), reduced psychological distress (12-item General Health Questionnaire –3.92; p = 0.01) and increased capability-adjusted life-years [+0.017; 95% confidence interval (CI) 0.001 to 0.031] at 6 months in the intervention arm than the TAU arm, with no differences in other outcomes. NHS and carer support costs were variable but, overall, were lower in the intervention arm than the TAU arm. The main limitation was difficulty maintaining outcome assessor blinding. Conclusions: Evidence is lacking to inform frailty prevention service design, with no large-scale trials of multidomain interventions. From stakeholder/public perspectives, new frailty prevention services should be personalised and encompass multiple domains, particularly socialising and mobility, and can be delivered by trained non-specialists. Our multicomponent health promotion intervention was acceptable and delivered at modest cost. Our small study shows promise for improving clinical outcomes, including functioning and independence. A full-scale individually RCT is feasible. Future work: A large, definitive RCT of the HomeHealth service is warranted. Study registration: This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials ISRCTN11986672. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 73. See the NIHR Journals Library website for further project information.

Estimates of the number of seamounts occurring worldwide are high and increasing, largely because of improved remote-sensing capabilities. Numbers have grown from a baseline of 15,000 (Wessel, 2001; Marova 2002) to more than 45,000 seamounts worldwide. High-end estimates are in the hundreds of thousands (Hillier and Watts, 2007; Kitchingman et al., 2007; Wessel, 2007; Wessel et al., 2010). So, it is logical to ask: What is the total area of the seamount biome? If the world’s seamount features were assembled into a continuous region, how large would this place be? How would the area of the seamount biome compare to continents, and to other marine biomes? These data would be informative, because terrestrial biomes are fairly well resolved and enumerated (Udvardy, 1975; Woodward, 2003), but marine biomes are less well mapped and understood.

To examine risk for mycosis among persons with silicosis, we examined US mortality data for 1979–2004. Persons with silicosis were more likely to die with pulmonary mycosis than were those without pneumoconiosis or those with more common pneumoconioses. Health professionals should consider enhanced risk for mycosis for silica-exposed patients.

Pulmonary hypertension is a common but often overlooked complication associated with thalassemia syndromes. There are limited data on the safety and efficacy of selective pulmonary vasodilators in this at-risk population. We, therefore, designed a 12-week, open-label, phase 1/2, pilot-scale, proof-of-principle trial of sildenafil therapy in 10 patients with β-thalassemia and at increased risk of pulmonary hypertension based on an elevated tricuspid regurgitant jet velocity >2.5 m/s on Doppler-echocardiography. Variables compared at baseline and after 12 weeks of sildenafil treatment included Doppler-echocardiographic parameters, 6-minute walked distance, Borg Dyspnea Score, New York Heart Association functional class, pulmonary function, and laboratory parameters. Treatment with sildenafil resulted in a significant decrease in tricuspid regurgitant jet velocity by 13.3% (3.0±0.7 versus 2.6±0.5 m/s, P=0.04), improved left ventricular end systolic/diastolic volume, and a trend towards a improved New York Heart Association functional class. No significant change in 6-minute walked distance was noted. Sildenafil was well tolerated, although minor expected adverse events were commonly reported. The total dose of sildenafil (mg) was strongly correlated with percent change in nitric oxide metabolite concentration in the plasma (ρ=0.80, P=0.01). There were also significant increases in plasma and erythrocyte arginine concentrations. Our study suggests that sildenafil is safe and may improve pulmonary hemodynamics in patients at risk of pulmonary hypertension; however, it was not demonstrated to improve the distance walked in 6 minutes. Clinical trials are needed to identify the best treatment strategy for pulmonary hypertension in patients with β-thalassemia. (clinicaltrials.gov identifier: NCT00872170)

MR has become a reliable and noninvasive method of hepatic iron quantification. Currently, most of the hepatic iron quantification is performed on 1.5 T MR, and the biopsy measurements have been paired with R2 and R2* values for 1.5 T MR. As the use of 3 T MR scanners is steadily increasing in clinical practice, it has become important to evaluate the practicality of calculating iron burden at 3 T MR. Hepatic iron quantification on 3 T MR requires a better understanding of the process and more stringent technical considerations. The purpose of this work is to focus on the technical challenges in establishing a relationship between T2* values at 1.5 T MR and 3 T MR for hepatic iron concentration (HIC) and to develop an appropriately optimized MR protocol for the evaluation of T2* values in the liver at 3 T magnetic field strength. We studied 22 sickle cell patients using multiecho fast gradient-echo sequence (MFGRE) 3 T MR and compared the results with serum ferritin and liver biopsy results. Our study showed that the quantification of hepatic iron on 3 T MRI in sickle cell disease patients correlates well with clinical blood test results and biopsy results. 3 T MR liver iron quantification based on MFGRE can be used for hepatic iron quantification in transfused patients.

Relatar um caso de sobrecarga de ferro secundária à xerocitose, uma doença rara, em uma adolescente, diagnosticada por meio de ressonância magnética em T2*. Relatamos o caso de uma paciente sintomática com xerocitose, nível de ferritina de 350ng/mL e sobrecarga de ferro cardíaca significativa. Ela foi diagnosticada por ressonância magnética em T2* e recebeu terapia de quelação. Análise por ectacitometria confirmou o diagnóstico de xerocitose hereditária. Na sequência, a ressonância magnética em T2* demonstrou resolução completa da sobrecarga de ferro em vários órgãos e novo ecocardiograma revelou resolução completa das alterações cardíacas anteriores. A paciente permanece em terapia de quelação. Xerocitose é uma desordem genética autossômica dominante rara, caracterizada por estomatocitose desidratada. O paciente pode apresentar fadiga intensa e sobrecarga de ferro. Sugerimos o uso regular de ressonância magnética em T2* para o diagnóstico e controle da resposta à quelação de ferro em xerocitose e acreditamos que o exame pode ser útil também em outras anemias hemolíticas que necessitam de transfusões.