Segmentation of CT Lung Images Using FCM with Active Contour and CNN Classifier

Objective: Lung cancer is one of the unsafe diseases for human which reduces the patient life time. Generally, most of the lung cancers are identified after it has been spread into the lung parts and moreover it is difficult to find the lung cancer at the early stage. It requires radiologist and special doctors to find the tumoral tissue of the lung cancer. For this reason, the recommended work helps to segment the tumoral tissue of CT lung image in an effective way. Methods:  The research work uses hybrid segmentation technique to separate the lung cancer cells to diagnose the lung tumour. It is a technique which combines active contour along with Fuzzy c means to diagnose the tumoral tissue. Further the segmented portion was trained by Convolutional Neural Network (CNN) in order to classify the segmented region as normal or abnormal. Results: The evaluation of the proposed method was done by analyzing the results of test image with the ground truth image. Finally, the results of the implemented technique provided good accuracy, Peak signal to noise ratio (PSNR), Mean Square Error (MSE) value. In future the other techniques can be utilized to improve the details before segmentation. The proposed work provides 96.67 % accuracy. Conclusion: Hybrid segmentation technique involves several steps like preprocessing, binarization, thresholding, segmentation and feature extraction using GLCM.     

TOPSIS法和秩和比法模糊联合在基本公共卫生服务质量综合评价中的应用研究

背景国家基本公共卫生服务项目的开展是我国新医改的重要举措，自2009年国家基本公共卫生服务项目开展后，其服务经费与服务项目不断扩增，由于涉及指标较多，覆盖面较广，探寻科学、客观、全面的基本公共卫生服务综合评价方法十分必要。目的探索适宜的基本公共卫生服务质量综合评价方法，通过质量评价为调整相关政策和提高服务质量提供依据。方法2019年2—4月，采用多阶段立意抽样方式从Z省南部、中部和北部地区共选取24家社区卫生服务中心（乡镇卫生院）作为评价对象，记为机构A~X。采用逼近理想解排序法（TOPSIS法）、秩和比法及二者模糊联合的方法对24家社区卫生服务中心（乡镇卫生院）2018年基层医疗卫生机构基本公共卫生服务质量进行综合评价（参考2018年国家基本公共卫生服务项目选取12项评价指标）。结果在TOPSIS法评价中，Ci值排名前三名的为A（0.917 4）、C（0.875 9）和G（0.787 9），Ci值排名后三名的为I（0.414 2）、W（0.413 7）和N（0.407 7）。在秩和比法评价中，RSR值排名前三名的为A（0.890 6）、G（0.765 6）和C（0.711 8），RSR值排名后三名的为V（0.381 9）、W（0.362 8）和K（0.357 6）。根据模糊集理论，将W1Ci+W2RSR值进行排序，依据"择多原则"，排名前三名的分别为A、C和G，排名后三名的分别为I、K和W，这与TOPSIS法和秩和比法的评价结果基本一致。结论TOPSIS法和秩和比法模糊联合得到的评价结果及影响因素与其他研究结果相一致，并且两者联用能克服单一使用TOPSIS法或秩和比法的局限性，适宜在基本公共卫生服务质量评价中推广应用。     

Scholastic achievement among children enrolled in the Seychelles Child Development Study

The Seychelles Child Development Study is a longitudinal cohort study following a group of 779 children exposed prenatally to methyl mercury (MeHg) through a maternal diet high in fish. The cohort has been examined six times beginning in infancy with no consistent evidence of adverse effects. In fact, their performance resembles what would be expected from normal children of comparable ages growing up in western cultures. During a neurodevelopment assessment at 66 months, the children were tested for scholastic achievement using the Woodcock Johnson Tests of Achievement. Their reading scores were depressed relative to US norms while arithmetic scores were within normal limits. This disparity was not evident at 107 months; in fact, reading achievement scores far exceeded expected performance relative to US norms, with over 75% of the cohort obtaining scores at or above the 90th percentile. This study reports a secondary analysis of the scholastic achievement data to test the hypothesis that the results obtained in the primary analysis were probably due to the onset of the primary school curriculum between the first and second testing, and not to inherent cognitive deficits among the children at 66 months. The results suggest that a combination of reading instruction and characteristically consistent letter-sound relationships in Creole, the language spoken at home by the majority of Seychellois families, probably accounted for the high achievement scores at 107 months.     

Pharmacological therapy selection of type 2 diabetes based on the SWARA and modified MULTIMOORA methods under a fuzzy environment

Medication selection for Type 2 Diabetes (T2D) is a challenging medical decision-making problem involving multiple medications that can be prescribed to control the patient’s blood glucose. The wide range of hyperglycemia lowering agents with varying effects and various side effects makes the decision quite difficult. This paper presents computer-aided medical decision support using a fuzzy Multi-Criteria Decision-Making (MCDM) model that hybridizes a Step-wise Weight Assessment Ratio Analysis (SWARA) method with a modification of Fuzzy Multi-Objective Optimization on the basis of a Ratio Analysis plus the full multiplicative form (FMULTIMOORA) method for pharmacological therapy selection of T2D. It makes the use of SWARA for obtaining the relative significance of every selected criterion by soliciting experts’ opinions and FMULTIMOORA method for evaluation of each alternative according to all criteria based on a published clinical guideline. In this paper, an extended reference point approach is considered in the proposed hybrid MCDM model that resolves the classic reference point limitations and improves the FMULTIMOORA ranking procedure. Computational results indicate that Metformin is confirmed as the first-line medication and Sulfonylurea as the second-line add-on therapy. The Glucagon-like peptide-1 receptor agonist, Dipeptidyl peptidase-4 inhibitor, and Insulin are placed 3rd, 4th, and 5th, respectively. A sensitivity analysis is conducted to validate the model performance by comparing its result with studies in the literature, other fuzzy MCDM techniques and an interval MULTIMOORA method based on an observational dataset. The close correspondence between the final rankings of anti-diabetic agents resulted from the proposed hybrid model and other methodologies provide significant implications for endocrinologists to refer.     

应用模糊数学评价护理服务满意度的研究

目的了解患者及家属对精神科门诊护士服务的满意度，分析影响因素，提出护理对策。方法采用自行设计的问卷调查某精神病专科医院门诊患者及家属903名，采用模糊数学综合评价法计算护理服务满意度，运用多元逐步回归法分析影响满意度的相关因素。结果护理服务满意度为8720％。就诊次数、居住地、付款方式和职业是影响患者满意度的因素。结论部分患者及家属对个别服务项目仍有不满意，需要进一步强化“以人为本”的服务理念，持续改进工作，以提高满意度。     

关键知情人对河南省社区卫生服务机构反应性的评价研究

目的:了解河南省社区卫生服务机构反应性水平。方法:采用制定的《河南省社区卫生反应性调查表(关键知情人)》问卷,调查社区卫生服务机构关键知情人。采用多输入优序图列法确定河南省社区卫生服务机构反应性各维度权重,采用模糊综合评价法评价反应性水平,采用反应性不平等指数测量反应性分布。结果:共调查有效关键知情人431位。问卷各维度Cronbachα系数均大于0.623,总量表Cronbachα系数为0.850;重测信度的各维度相关系数均大于0.907。反应性水平与分布指数分别为8.33和0.2744,各维度重要性排序为:及时关注尊严基础设施交流保密性社会支持选择性自主性。关键知情人认为脆弱人群在社区卫生机构有时或经常受到不公平对待的比例约为50%。结论:关键知情人认为河南省社区卫生服务机构的反应性水平总体较高,反应性分布比较均衡。但认为在基础设施、对患者的隐私保护、与患者的交流沟通等方面存在很大不足。     

Transcranial direct current stimulation of the posterior parietal cortex modulates arithmetic learning

The successful acquisition of arithmetic skills is an essential step in the development of mathematical competencies and has been associated with neural activity in the left posterior parietal cortex (PPC). It is unclear, however, whether this brain region plays a causal role in arithmetic skill acquisition and whether arithmetic learning can be modulated by means of non‐invasive brain stimulation of this key region. In the present study we addressed these questions by applying transcranial direct current stimulation (tDCS) over the left PPC during a short‐term training that simulates the typical path of arithmetic skill acquisition (specifically the transition from effortful procedural to memory‐based problem‐solving strategies). Sixty participants received either anodal, cathodal or sham tDCS while practising complex multiplication and subtraction problems. The stability of the stimulation‐induced learning effects was assessed in a follow‐up test 24 h after the training. Learning progress was modulated by tDCS. Cathodal tDCS (compared with sham) decreased learning rates during training and resulted in poorer performance which lasted over 24 h after stimulation. Anodal tDCS showed an operation‐specific improvement for subtraction learning. Our findings extend previous studies by demonstrating that the left PPC is causally involved in arithmetic learning (and not only in arithmetic performance) and that even a short‐term tDCS application can modulate the success of arithmetic knowledge acquisition. Moreover, our finding of operation‐specific anodal stimulation effects suggests that the enhancing effects of tDCS on learning can selectively affect just one of several cognitive processes mediated by the stimulated area.     

Educational audit on drug dose calculation learning in a Tanzanian school of nursing

Background

Patient safety is a key concern for nurses; ability to calculate drug doses correctly is an essential skill to prevent and reduce medication errors. Literature suggests that nurses'' drug calculation skills should be monitored.

Objective

The aim of the study was to conduct an educational audit on drug dose calculation learning in a Tanzanian school of nursing. Specific objectives were to assess learning from targeted teaching, to identify problem areas in performance and to identify ways in which these problem areas might be addressed.

Methods

A total of 268 registered nurses and nursing students in two year groups of a nursing degree programme were the subjects for the audit; they were given a pretest, then four hours of teaching, a post-test after two weeks and a second post-test after eight weeks.

Results

There was a statistically significant improvement in correct answers in the first post-test, but none between the first and second post-tests. Particular problems with drug calculations were identified by the nurses / students, and the teacher; these identified problems were not congruent.

Conclusion

Further studies in different settings using different methods of teaching, planned continuing education for all qualified nurses, and appropriate pass marks for students in critical skills are recommended.