PubMed Health⌕ Search

Biomedical subjects

David McLean

Publications and source records attributed to David McLean.

9 recordsLinked to original sources

On global-local artificial neural networks for function approximation.

We present a hybrid radial basis function (RBF) sigmoid neural network with a three-step training algorithm that utilizes both global search and gradient descent training. The algorithm used is intended to identify global features of an input-output relationship before adding local detail to the approximating function. It aims to achieve efficient function approximation through the separate identification of aspects of a relationship that are expressed universally from those that vary only within particular regions of the input space. We test the effectiveness of our method using five regression tasks; four use synthetic datasets while the last problem uses real-world data on the wave overtopping of seawalls. It is shown that the hybrid architecture is often superior to architectures containing neurons of a single type in several ways: lower mean square errors are often achievable using fewer hidden neurons and with less need for regularization. Our global-local artificial neural network (GL-ANN) is also seen to compare favorably with both perceptron radial basis net and regression tree derived RBFs. A number of issues concerning the training of GL-ANNs are discussed: the use of regularization, the inclusion of a gradient descent optimization step, the choice of RBF spreads, model selection, and the development of appropriate stopping criteria.

Algorithms↗

Spectroscopic assessment of dermal melanin using blue vitiligo as an in vivo model.

BACKGROUND: Spectroscopic methods have been used to analyze in vivo melanin in the past but the specific effect of melanin depth on autofluorescence and reflectance spectroscopy has not been determined. In patients with blue vitiligo, three distinctive clinicopathologic patterns are present: (1) normal skin with normal epidermal melanin pigmentation (2), skin of blue vitiligo with dermal melanin pigmentation, and (3) tissue of regular vitiligo with no melanin pigmentation. Blue vitiligo may thus serve as an in vivo model to assess dermal pigment using spectroscopic techniques. OBJECTIVES: To evaluate the reflectance and autofluorescence spectra of a patient with blue vitiligo in order to assess the effect of melanin pigmentation and its localization on the optical properties of the skin. METHODS: The blue-gray, normal and depigmented lesions of a patient with blue vitiligo were analyzed using reflectance and fluorescent spectroscopy. The condition was likely induced by a phototoxic reaction in a patient with pre-existing vitiligo. These data were then correlated to the histologic and electron microscopic findings present in the various types of lesions. RESULTS: Reflectance spectroscopy detected little difference in spectral shape between skin sites affected by blue vitiligo vs. vitiligo. Autofluorescence spectroscopy detected an apparent difference between the two types of lesions, with the blue-gray lesions (blue vitiligo) showing lower fluorescence intensity and spectral maximum position red-shifted compared with regular vitiligo, whereas regular vitiligo showed more intense hemoglobin absorption than the blue vitiligo. CONCLUSIONS: Dermal melanin present in blue vitiligo can be well characterized by autofluorescence spectroscopy, while little difference in reflectance spectral shape exists between vitiligo and blue vitiligo. Thus, autofluorescence spectroscopy may better identify deeper structures in skin tissue, such as melanin, than reflectance spectroscopy.

Humans↗

Cancer mortality in workers exposed to organochlorine compounds in the pulp and paper industry: an international collaborative study.

The objective of this study was to evaluate cancer mortality in pulp and paper industry workers exposed to chlorinated organic compounds. We assembled a multinational cohort of workers employed between 1920 and 1996 in 11 countries. Exposure to both volatile and nonvolatile organochlorine compounds was estimated at the department level using an exposure matrix. We conducted a standardized mortality ratio (SMR) analysis based on age and calendar-period-specific national mortality rates and a Poisson regression analysis. The study population consisted of 60,468 workers. Workers exposed to volatile organochlorines experienced a deficit of all-cause [SMR = 0.91; 95% confidence interval (CI), 0.89-0.93] and all-cancer (SMR = 0.93; 95% CI, 0.89-0.97) mortality, with no evidence of increased risks for any cancer of a priori interest. There was a weak, but statistically significant, trend of increasing risk of all-cancer mortality with increasing weighted cumulative exposure. A similar deficit in all-cause (SMR = 0.94; 95% CI, 0.91-0.96) and all-cancer (SMR = 0.94; 95% CI, 0.89-1.00) mortality was observed in those exposed to nonvolatile organochlorines. No excess risk was observed in cancers of a priori interest, although mortality from Hodgkin disease was elevated (SMR = 1.76; 95% CI, 1.02-2.82) . In this study we found little evidence that exposure to organochlorines at the levels experienced in the pulp and paper industry is associated with an increased risk of cancer, apart from a weak but significant association between all-cancer mortality and weighted cumulative volatile organochlorine exposure.

Humans↗

Photodynamic therapy of multiple nonmelanoma skin cancers with verteporfin and red light-emitting diodes: two-year results evaluating tumor response and cosmetic outcomes.

BACKGROUND: Efficient treatment of patients with multiple synchronous nonmelanoma skin cancers represents a therapeutic challenge. OBJECTIVE: To study the safety and efficacy of photodynamic therapy (PDT) with verteporfin and red light in the treatment of multiple nonmelanoma skin cancers. DESIGN: Open-label, randomized, multicenter, dose-ranging phase 2 study conducted at 4 North American university-based dermatology clinics. PATIENTS: Fifty-four patients with 421 multiple nonmelanoma skin cancers including superficial and nodular basal cell carcinoma and squamous cell carcinoma in situ (Bowen disease). METHODS: A single intravenous infusion of 14 mg/m(2) of verteporfin followed 1 to 3 hours later by exposure of tumors to 60, 120, or 180 J/cm(2) of red light (688 +/- 10 nm) from a light-emitting diode panel. MAIN OUTCOME MEASURES: Pathologic response of treated sites was assessed at 6 months. Clinical and cosmetic responses were assessed and graded at 6 weeks, 3 months, and 6 months after verteporfin PDT, with optional follow-up visits at 12, 18, and 24 months. RESULTS: The histopathologic response, defined as absence of tumor on biopsy specimens 6 months after verteporfin PDT, ranged from 69% at 60 J/cm(2) to 93% at 180 J/cm(2). At 24 months of follow-up (276 tumors in 31 patients), the clinical complete response rate ranged from 51% at 60 J/cm(2) to 95% at 180 J/cm(2). No significant systemic adverse events were observed; most events occurred at the treated tumor sites and included events such as pain. Overall, 65% (95% confidence interval, 58%-71%) of tumors were judged to have good to excellent cosmesis at 24 months. CONCLUSION: A single course of verteporfin PDT showed treatment benefit for patients with multiple nonmelanoma skin cancers.

Adult↗

Parametric modeling of narrowband UV-B phototherapy for vitiligo using a novel quantitative tool: the Vitiligo Area Scoring Index.

BACKGROUND: There is currently no quantitative tool for evaluating vitiligo treatment response using parametric methods. OBJECTIVE: To develop and apply a simple clinical tool, the Vitiligo Area Scoring Index (VASI), to model the response of vitiligo to narrowband UV-B (NB-UV-B) phototherapy using parametric tests. DESIGN: Prospective, randomized, controlled, bilateral left-right comparison trial. SETTING: North American tertiary care, university-affiliated phototherapy center. PATIENTS: Patients older than 18 years with stable vitiligo involving at least 5% of their total body surface in a symmetric distribution. INTERVENTION: Treatment with NB-UV-B was given 3 times a week to half of the body on all patients for either 60 treatments or 6 months. The contralateral side served as a no-treatment control. MAIN OUTCOME MEASURE: Repigmentation was assessed using the VASI, which was based on a composite estimate of the overall area of vitiligo patches at baseline and the degree of macular repigmentation within these patches over time. The VASI was validated separately against physician and patient global assessments. The overall reductions in VASI for NB-UV-B and control groups were modeled by multilevel regression with random effects and compared parametrically. RESULTS: The VASI scoring correlated well with both patient and physician global assessments (P =.05 and P<.001, respectively, using ordinal logistic regression). The extent of repigmentation after 6 months on the treated side was 42.9% (95% confidence interval, 26.7%-59.0%) vs 3.3% (95% confidence interval -19.3% to 30.0%) on the untreated side (P<.001). A significant difference between control and NB-UV-B groups was apparent within the first 2 months of therapy. The legs, trunk, and arms were much more likely to repigment than the feet and hands. CONCLUSIONS: The VASI is a quantitative clinical tool that can be used to evaluate vitiligo parametrically. Patients treated with NB-UV-B can be expected to achieve approximately 42.9% repigmentation of their vitiligo after 6 months of treatment, with the greatest response being achieved over the trunk and nonacral portions of the extremities.

Adult↗

Using the internet to assess and teach medical students in dermatology.

BACKGROUND AND OBJECTIVES: We wish to develop and evaluate a user-friendly online interactive teaching and examination model as an adjunct to traditional bedside teaching of medical students during a clinical rotation in dermatology. METHODS: Following completion of an online examination, senior medical students at the University of British Columbia (n = 178) were asked to complete an online survey to evaluate their acceptance of this new method. The online examination model was evaluated through students' responses to the questionnaire-based evaluation they were asked to complete following their examination. Responses were evaluated on a standardized 5-point scale. RESULTS: A high response rate was achieved (98.9%). Overall, 93% of senior medical students felt that the Internet was a useful and effective way to administer a dermatology examination. Most (90%) preferred the online examination to a traditional paper-and-pencil examination and the majority (88%) felt that the quality of digital images presented was sufficient to make an accurate diagnosis. In addition, students strongly supported the further development of teaching resources on the web and would use these resources in learning dermatology (93%). CONCLUSIONS: The development of an online interactive examination tool for dermatology is technically feasible with current technology. Senior medical students are not only accepting of this new technology but also prefer it to more traditional formats and indicate enthusiasm for the development of further online teaching resources in dermatology.

British Columbia↗

An empirical comparison of back propagation and the RDSE algorithm on continuously valued real world data.

The ability of a neural network to generalise is dependent on how representative the training patterns were of the whole data domain, and how smoothly the network has fitted to these patterns [Sethi, I.K. (1990). IEEE International Joint Conference on Neural Networks, Seattle, WA, Vol. 2, pp. 219-224]. In non-scaled continuous data domains, training examples will lie at differing distances from each other, making the fitting problem more difficult and varied. This paper introduces a new neuron with an adaptive steepness parameter, implemented as an extra internal connection, which is altered to better interpolate between the data points that its hyperplane divides. Networks of the new neuronal model are trained using a new paradigm entitled the random directed search by entropy algorithm (RDSE). This involves constructing a network by training one neuron at a time and freezing the weights. Each neuron is trained using directed random search [Baba (1989). Neural Networks, 2, 367-373] to find a hyperplane that separates examples by minimising an entropy measure [Quinlan (1986). Induction of Decision Trees, Machine Learning, Vol. 1, pp. 81-106]. This training paradigm solves the problem of pre-defining a network topology, has few problems with local minima, can handle unscaled continuous input data and can be fully trained in a relatively short time scale when compared with other methods, e.g. back propagation (BP).An example benchmark problem is used to illustrate the effects of the new neuronal model, and results for two real world data domains are given which display an improved classification rate when compared against networks with a constant steepness value for every neuron. An empirical comparison between BP and RDSE for the two data sets are also given. These results display improved training times, robustness and classification rates by RDSE when compared against BP.

Journal Article↗

The health buck stops where? Thematic framing of health discourse to understand the context for CVD prevention.

Using a constructed week methodology, we analyzed media summaries for the type of health discourse (health care delivery, disease-specific prevention, lifestyle risk factors, public/environmental health disease, social determinants of health) portrayed over a 5-year period as a means of describing the context within which health staff worked to prevent heart disease in one Canadian province. The results reveal that heart disease received very little media coverage, despite provincial health data revealing it to be the leading cause of mortality, morbidity, and health care costs. Coverage of the health care system dominated the media landscape over the 5-year period. The study findings also suggest that the health discourses in the media summaries were represented as primarily thematic, rather than as episodic narratives, relieving any one level of government as entirely responsible for the health of its constituents. Media advocacy strategies may be a means to redress the imbalance of health discourses presented by the media.

British Columbia↗

Changes in nuclei and peritumoral collagen within nodular basal cell carcinomas via confocal micro-Raman spectroscopy.

Confocal micro-Raman spectroscopy is used to probe the nuclei of normal human epidermal cells and epidermally derived cancer cells from nodular basal cell carcinomas. Clear differences are seen between the spectra. The nuclei of tumor cells appear to have different contributions from nucleic acids, histones, and proteins with an actin-like spectrum than those of normal epidermal cells. Changes in the contribution of DNA to the spectra are consistent with the staining of conventional histopathologic specimens. We also obtain spectra of the dermis, where it is found that the dermis close to tumor boundaries is not simply deficient in collagen, but shows signs of structural changes as well.

Basal Cell Carcinoma↗