Design and characterization of a digital image acquisition system for whole-specimen breast histopathology

We have developed a digital histopathology imaging system capable of producing a three-dimensional (3D) representation of histopathology from an entire lumpectomy specimen. The system has the potential to improve the accuracy of surgical margin assessment in the treatment of breast cancer by providing finer sampling and 3D visualization. A scanning light microscope was modified to allow digital photomicrography of a stack of large (up to 120x170 mm2) histology slides cut serially through the entire specimen. The images are registered and displayed in 2D and 3D. The design of the system, which reduces or eliminates the appearance of 'tiling' and 'seam' artefacts inherent in the scanning method, is described and its resolution, contrast/noise and coverage properties are characterized through measurements of the modulation transfer function (MTF), depth of field (DOF) and signal difference to noise ratio (SDNR). The imaging task requires a lateral resolution of 5 microm, an SDNR of 5 between relevant features, 'tiling artefact' at a level below the detectability threshold of the eye, and 'seam artefact' of less than 5-10 microm. The tests demonstrate that the system is largely adequate for the imaging task, although further optimizations are required to reduce the degradation of coverage incurred by seam artefact.     

Design and development of an automatic data acquisition system for a balance study using a smartcard system

For measurement value logging of board angle values during balance training, it is necessary to develop a measurement system. This study will provide data for a balance study using the smartcard. The data acquisition comes automatically. An individually training plan for each proband is necessary. To store the proband identification a smartcard with an I2C data bus protocol and an E2PROM memory system is used. For reading the smartcard data a smartcard reader is connected via universal serial bus (USB) to a notebook. The data acquisition and smartcard read programme is designed with Microsoft® Visual C#. A training plan file contains the individual training plan for each proband. The data of the test persons are saved in a proband directory. Each event is automatically saved as a log-file for the exact documentation. This system makes study development easy and time-saving.     

Facilitating progress in health behaviour theory development and modification: the reasoned action approach as a case study

This paper explores the question: what are barriers to health behaviour theory development and modification, and what potential solutions can be proposed? Using the reasoned action approach (RAA) as a case study, four areas of theory development were examined: (1) the theoretical domain of a theory; (2) tension between generalisability and utility, (3) criteria for adding/removing variables in a theory, and (4) organisational tracking of theoretical developments and formal changes to theory. Based on a discussion of these four issues, recommendations for theory development are presented, including: (1) the theoretical domain for theories such as RAA should be clarified; (2) when there is tension between generalisability and utility, utility should be given preference given the applied nature of the health behaviour field; (3) variables should be formally removed/amended/added to a theory based on their performance across multiple studies and (4) organisations and researchers with a stake in particular health areas may be best suited for tracking the literature on behaviour-specific theories and making refinements to theory, based on a consensus approach. Overall, enhancing research in this area can provide important insights for more accurately understanding health behaviours and thus producing work that leads to more effective health behaviour change interventions.     

Fetal development of baroreflex sensitivity: the chicken embryo as a case model

The baroreflex is the main short term compensatory mechanism to buffer blood pressure changes and maintain circulatory homeostasis. Its ontogeny and importance during prenatal life is not fully understood so we used broiler chickens to investigate the maturation of the baroreflex in late incubation using a novel method that measured changes in heart rate during spontaneous fluctuations in blood pressure. Our results suggest that a baroreflex is already functional at d17 with no indication of further maturation in terms of sensitivity (gain at 17 d was 52.9±8.3 and at 20 d 69.5±16.2 ms kPa(-1)). The physiological relevance of these values is shown using data surrogation methods. Although the results contrast with the progressive baroreflex maturation indicated by the pharmacological method, we sustain that both methods provide information on baroreflex regulation. While the spontaneous method evaluates truly physiological (but small) pressure changes, the pharmacological method provides a more consistent and repetitive challenge for the reflex that requires a different recruitment of baroreflex effectors.     

Environmental influences on human growth and development: Historical review and case study of contemporary influences

Over the past 100 years, the study of environmental influences on human physical growth and development has focused on the influences of social and economic factors; family and household characteristics; urbanization/modernization; nutrition; and features of the physical environment such as altitude, temperature and climate. Continuing in this tradition are current investigations into the roles of pollutants and other aspects of the human-made environment in affecting patterns of human growth and development, specifically the timing of sexual maturation and the development of obesity. Some of the methodological problems in conducting such studies are presented, as are results from an ongoing investigation among one Native American community that show relationships of pollutants to sexual maturation, overweight/obesity and thyroid system function which can impact growth and maturation.     

Postnatal development of the basolateral complex of rabbit amygdala: a stereological and histochemical study

The aim of the study was to estimate developmental changes in the rabbit basolateral complex (BLC) by stereological and histochemical methods. Material consisted of 45 brains of New Zealand rabbits (aged from 2 to 180 days, P2 to P180) of both sexes, divided into nine groups. The following parameters were estimated: volume of the cerebral hemisphere; volume of the whole BLC and of particular BLC nuclei; neuronal density and total number of neurons in these nuclei. Developmental changes in acetylcholinesterase (AChE) activity in the BLC were also examined. The volume of the cerebral hemisphere increased until P30, whereas volumes of nuclei increased for longer--until P90. The density of neurons in all nuclei studied reached the level characteristic for an adult animal at about P30. The total number of neurons in the dorsolateral division of the lateral nucleus (Ldl) stabilized the earliest--between P30 and P60, whereas in the ventromedial division of the lateral nucleus (Lvm), basomedial (BM) and basolateral (BL) nuclei the number stabilized later--between P60 and P90. AChE activity appears minimal in the BLC on P2, reaches a maximum on P30 and then decreases to the level characteristic of an adult animal on P60. AChE activity was greater in BL than in other nuclei in all age groups. Reaching adult AChE activity 1 month earlier than the total number of neurons in the BLC may indicate a role of the cholinergic system in BLC maturation.     

Seeds of change: A qualitative case study of a neighborhood youth program

Even within economically disadvantaged neighborhoods, programs fostering protective factors can shape youth outcomes. One positive youth development (PYD) program— Seeds of Change—employs teenagers in an urban neighborhood in Ohio and uses goats and community gardens to promote adolescent development. The current study used semi-structured interviews with adolescents (N = 7, ages 16–20) to conduct a case study of the program. The case study describes youth's perceptions of the neighborhood, the program, and future directions; responses were analyzed using content analysis. Youth described that Seeds of Change enacts change on multiple levels of the social ecology by emphasizing individual growth, building a social support system with peers and adults, and increasing both tangible resources and positive relationships throughout the neighborhood. Seeds of Change promotes positive socialization, increases resources, and embodies multiple elements of effective PYD programming.     

Parenting and psychosocial development of IVF children: a follow-up study

BACKGROUND: This report details a follow-up study of the parent-child relationship and the child's psychosocial development after IVF. The pilot study compared 31 IVF families and 31 families with a naturally conceived child when the children were aged 2 years. Twenty-seven IVF and 23 control families participated again when the children were aged 8-9 years. METHODS: Fathers and mothers completed questionnaires assessing parenting variables and the child's behaviour. For most children, behavioural ratings were also obtained from the child's teacher. RESULTS: No significant differences were found between IVF and control parents' reports of child behaviour, parenting behaviour, parenting stress and most of the parenting goals. The parenting goal adjustment was significantly more important for IVF than for control fathers; religion was more important for IVF than for naturally conceiving mothers. Teacher ratings of the child's behaviour did not differ significantly between the IVF and control groups. All couples but one had talked to other persons about the IVF conception; 75% of the IVF parents had not yet informed their children. IVF parents who had informed their child observed more (internalizing and for fathers also overall) problem behaviours in their child, compared with IVF parents who had not yet disclosed the IVF conception. CONCLUSIONS: Parenting and the children's psychosocial development do not differ significantly between IVF families and control families.     

Risk factors and outcomes for the acquisition of carbapenem-resistant Gram-negative bacillus bacteremia: A retrospective propensity-matched case control study

Background/purpose

A substantial number of carbapenem-resistant Gram-negative bacilli (CR GNB) have been identified among the etiologic multidrug-resistant GNB in healthcare-associated infections. For achieving a better therapeutic outcome by minimizing inappropriate empirical antibiotic treatment before blood culture and susceptibility testing results are available, it is very important to identify patients who are at risk for the development of CR GNB bacteremia.

Preliminary study on the development of a system dynamics model: the case of EVAHEART

The Japanese medical device industry’s stagnation over the years can be attributed to the uncertainty related to device development. The purpose of this study is to identify the major factors that impact development. We studied the ventricular assist device EVAHEART through interviews with the persons involved and created a development model using system dynamics. There are at least six stages in the device development process, including interactions with academia and the government. Through a simulation and comparison to Novacor, it was determined that the satisfaction of academia leads to government action in the subsequent measures. Our trial simulation of EVAHEART suggests that it has the potential to clarify unclear relationships in the development of devices.     

Risk-factors for the acquisition of imipenem-resistant Acinetobacter baumannii in Spain: a nationwide study

Potential risk-factors for the acquisition of imipenem-resistant Acinetobacter baumannii were investigated in a cohort study in 25 Spanish hospitals. The clonal relationship among isolates was determined by pulsed-field gel electrophoresis (PFGE). In total, A. baumannii was isolated from 203 patients, with imipenem-resistant (MIC(90) 128 mg/L) isolates being obtained from 88 patients (43%), and imipenem-susceptible isolates from 115 patients (57%). A wide clonal distribution was observed among the imipenem-resistant isolates, but spread of the same clone among centres was not demonstrated. The results indicated that imipenem-resistant A. baumannii is a widely distributed nosocomial pathogen in Spain and reaches an alarming frequency in some centres. Independent risk-factors for the acquisition of imipenem-resistant A. baumannii were a hospital size of >500 beds (multivariate OR, 6.5; 95% CI, 1.8--23), previous antimicrobial treatment (multivariate OR, 4.3; 95% CI, 1.6--11), a urinary catheter (multivariate OR, 2.7; 95% CI, 1.1--6.7) and surgery (multivariate OR, 2; 95% CI, 1.07--3.8).     

Congenital infantile digital fibromatosis: a case report and review of the literature

Infantile digital fibromatosis (IDF), also called inclusion body fibromatosis is an uncommon benign tumour occurring in the digits of young children. In about a third of cases, it is congenital and the diagnosis is based on the presence of peculiar intracytoplasmic inclusions on histology. Recurrence rate post-surgery is high. However, spontaneous regression has been reported. We present a case of a 5-month-old infant who had excision of a right second toe mass, which has been present from birth. Histological examination revealed this to be infantile digital fibromatosis. To the best of our knowledge, no report of this has been made in Nigeria. It is important that this diagnosis be entertained in young children with masses on the digits as this will influence the management instituted.     

The isolator piglet: a model for studying the development of adaptive immunity

The period from late gestation to weaning in neonatal mammals is a critical window when the adaptive immune system develops and replaces the protection temporarily provided by passive immunity and pre-adaptive antibodies. It is also when oral tolerance to dietary antigen and the distinction between commensal and pathogenic gut bacteria becomes established resulting in immune homeostasis. The reproductive biology of swine provides a unique model for distinguishing the effects of different factors on immune development during this critical period because all extrinsic factors are controlled by the experimenter. This chapter reviews this early stage of development and the usefulness of the piglet model for understanding events during this transitional stage. The review also describes the major features of the porcine immune system and the immune stimulatory and dysregulatory factors that act during this period. The value of the model to medical science in such areas as food allergy, organ transplantation, cystic fibrosis and the production of humanized antibodies for immuno-therapy is discussed.     

Evidence of early development of action planning in the human foetus: a kinematic study

The aim of the present study was to investigate whether foetal hand movements are planned and how they are executed. We performed a kinematic analysis of hand movements directed towards the mouth and the eyes in the foetuses of eight women with normally evolving pregnancies. At 14, 18 and 22 weeks of gestation, eight foetuses underwent a 20-min four-dimensional-ultrasound session. The video recordings for these movements were then imported into in-house software developed to perform kinematic analysis. We found that spatial and temporal characteristics of foetal movements are by no means uncoordinated or unpatterned. By 22 weeks of gestation the movements seem to show the recognizable form of intentional actions, with kinematic patterns that depend on the goal of the action, suggesting a surprisingly advanced level of motor planning.     

Medium-Term Effectiveness of a Comprehensive Internet-Based and Patient-Specific Telerehabilitation Program With Text Messaging Support for Cardiac Patients: Randomized Controlled Trial

BackgroundCardiac telerehabilitation has been introduced as an adjunct or alternative to conventional center-based cardiac rehabilitation to increase its long-term effectiveness. However, before large-scale implementation and reimbursement in current health care systems is possible, well-designed studies on the effectiveness of this new additional treatment strategy are needed.ObjectiveThe aim of this trial was to assess the medium-term effectiveness of an Internet-based, comprehensive, and patient-tailored telerehabilitation program with short message service (SMS) texting support for cardiac patients.MethodsThis multicenter randomized controlled trial consisted of 140 cardiac rehabilitation patients randomized (1:1) to a 24-week telerehabilitation program in combination with conventional cardiac rehabilitation (intervention group; n=70) or to conventional cardiac rehabilitation alone (control group; n=70). In the telerehabilitation program, initiated 6 weeks after the start of ambulatory rehabilitation, patients were stimulated to increase physical activity levels. Based on registered activity data, they received semiautomatic telecoaching via email and SMS text message encouraging them to gradually achieve predefined exercise training goals. Patient-specific dietary and/or smoking cessation advice was also provided as part of the telecoaching. The primary endpoint was peak aerobic capacity (VO₂ peak). Secondary endpoints included accelerometer-recorded daily step counts, self-assessed physical activities by International Physical Activity Questionnaire (IPAQ), and health-related quality of life (HRQL) assessed by the HeartQol questionnaire at baseline and at 6 and 24 weeks.ResultsMean VO₂ peak increased significantly in intervention group patients (n=69) from baseline (mean 22.46, SD 0.78 mL/[min*kg]) to 24 weeks (mean 24.46, SD 1.00 mL/[min*kg], P<.01) versus control group patients (n=70), who did not change significantly (baseline: mean 22.72, SD 0.74 mL/[min*kg]; 24 weeks: mean 22.15, SD 0.77 mL/[min*kg], P=.09). Between-group analysis of aerobic capacity confirmed a significant difference between the intervention group and control group in favor of the intervention group (P<.001). At 24 weeks, self-reported physical activity improved more in the intervention group compared to the control group (P=.01) as did the global HRQL score (P=.01).ConclusionsThis study showed that an additional 6-month patient-specific, comprehensive telerehabilitation program can lead to a bigger improvement in both physical fitness (VO₂ peak) and associated HRQL compared to center-based cardiac rehabilitation alone. These results are supportive in view of possible future implementation in standard cardiac care.