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Application of discrete data consistency conditions for selecting regularization parameters in PET attenuation map reconstruction.

Simultaneous emission and transmission measurement is appealing in PET due to the matching of geometrical conditions between emission and transmission and reduced acquisition time for the study. A potential problem remains: when transmission statistics are low, attenuation correction could be very noisy. Although noise in the attenuation map can be controlled through regularization during statistical reconstruction, the selection of regularization parameters is usually empirical. In this paper, we investigate the use of discrete data consistency conditions (DDCC) to optimally select one or two regularization parameters. The advantages of the method are that the reconstructed attenuation map is consistent with the emission data and that it accounts for particularity in the emission reconstruction algorithm and acquisition geometry. The methodology is validated using a computer-generated whole-body phantom for both emission and transmission, neglecting random events and scattered radiation. MAP-TR was used for attenuation map reconstruction, while 3D OS-EM is used for estimating the emission image. The estimation of regularization parameters depends on the resolution of the emission image controlled by the number of iterations in OS-EM. The computer simulation shows that, on one hand, DDCC regularized attenuation map reduces propagation of the transmission scan noise to the emission image, while on the other hand DDCC prevents excessive attenuation map smoothing that could result in resolution mismatch artefacts between emission and transmission.

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Bayesian image reconstruction for emission tomography based on median root prior.

The aim of the present study was to investigate a new type of Bayesian one-step late reconstruction method which utilizes a median root prior (MRP). The method favours images which have locally monotonous radioactivity concentrations. The new reconstruction algorithm was applied to ideal simulated data, phantom data and some patient examinations with PET. The same projection data were reconstructed with filtered back-projection (FBP) and maximum likelihood-expectation maximization (ML-EM) methods for comparison. The MRP method provided good-quality images with a similar resolution to the FBP method with a ramp filter, and at the same time the noise properties were as good as with Hann-filtered FBP images. The typical artefacts seen in FBP reconstructed images outside of the object were completely removed, as was the grainy noise inside the object. Quantitatively, the resulting average regional radioactivity concentrations in a large region of interest in images produced by the MRP method corresponded to the FBP and ML-EM results but at the pixel by pixel level the MRP method proved to be the most accurate of the tested methods. In contrast to other iterative reconstruction methods, e.g. ML-EM, the MRP method was not sensitive to the number of iterations nor to the adjustment of reconstruction parameters. Only the Bayesian parameter beta had to be set. The proposed MRP method is much more simple to calculate than the methods described previously, both with regard to the parameter settings and in terms of general use. The new MRP reconstruction method was shown to produce high-quality quantitative emission images with only one parameter setting in addition to the number of iterations.

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Advanced cardiac life support: update on recent guidelines and a look at the future.

The objectives of this article are to provide an update of the American Heart Association (AHA) 1992 National Conference guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care and to review the investigation and development of new methods of CPR which may be considered in future recommendations. Despite an organized approach to sudden cardiac arrest, survival in patients receiving CPR is in the range of 5-15%. The new AHA guidelines recommend standard manual CPR performed at a rate of 80-100 compressions/min and organized algorithms of advanced cardiac life support. These guidelines stress widespread community training and rapid response in the following sequence: (1) recognition of early warning signs, (2) activation of the emergency medical system (EMS), (3) basic CPR, (4) early defibrillation, (5) intubation, and (6) intravenous medication. Several new recommendations pertain specifically to in-hospital care and are, therefore, particularly relevant to physician management of cardiac arrest. The best predictor of survival in patients requiring circulatory support after cardiac arrest is attainable coronary and cerebral perfusion. Unfortunately, the minimal levels of end-organ perfusion required to sustain life are often difficult or impossible to achieve with standard manual cardiopulmonary resuscitation and several new techniques have therefore been introduced. The most promising of these techniques are (1) interposed abdominal compression, (2) pneumatic vest, and (3) active compression-decompression resuscitation. Each of these techniques offers unique advantages when compared with standard manual cardiopulmonary resuscitation. The 1992 National Conference recommendations provide a rational framework for the resuscitation of cardiac arrest victims. New methods of cardiopulmonary resuscitation are now available and investigation into these methods continues.(ABSTRACT TRUNCATED AT 250 WORDS)

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Mixed effects models with censored data with application to HIV RNA levels.

Mixed effects models are often used for estimating fixed effects and variance components in longitudinal studies of continuous data. When the outcome being modelled is a laboratory measurement, however, it may be subject to lower and upper detection limits (i.e., censoring). In this paper, the usual EM estimation procedure for mixed effects models is modified to account for left and/or right censoring.

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Paramedic documentation of indicators for cervical spine injury.

INTRODUCTION: Current paramedic training mandates complete immobilization of all patients, symptomatic or not, whose mechanism of injury typically is viewed as conducive to spinal trauma. It is common to observe confrontations between paramedics and walking, asymptomatic accident victims who fail to understand why they should "wear that collar and be strapped to that board." Immobilized, frustrated patients then may wait for hours in a busy emergency department until a physician declares them to be without spinal injury. Patients frequently refuse treatment and transport. HYPOTHESIS: Algorithms exist for physicians to "clear" the cervical spine (C-spine) without radiography. It was hypothesized that paramedics routinely assess and document these indicators in their patient evaluations. METHODS: A retrospective chart review was conducted on 161 patients (Group 1) admitted to a regional medical center with a diagnosis of C-spine injury over a 52-month period. The charts of 225 motor vehicle accident (MVA) victims (Group 2) transported by ambulance to the emergency department over a five-month period then were studied. Indicators for C-spine injury documented by emergency medical service (EMS) personnel were abstracted. RESULTS: All patients underwent mental status assessment and full spinal immobilization (neck and back) by EMS crews prior to transport to the hospital. Two or more indicators of possible C-spine injury were documented on each prehospital care report (PCR). CONCLUSION: Paramedics already assess most, if not all, of the criteria standard to C-spine clearance algorithms, but are inconsistent in their documentation of the presence or absence of all of the relevant findings.

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Physical limitations of the TOBEC method: accuracy and long-term stability.

While measurement of electrical conductivity provides one way of estimating body composition in live animals, the accuracy of methods based on this principle requires further study. In this work, we evaluate the effect of the ambient conditions and sample geometry on the response given by an SA-2 model (EM-SCAN) apparatus as well as the reproducibility of the measurements over time. A 2 degrees C variation of the sample temperature (a normal range for living animals) can result in a 6-10% variation in the response. When the conductive mass of a sample is increased in length, the response of the apparatus does not increase once the sample length reaches half the length of the measurement chamber. Samples having the same conductive mass but different shapes can show up to a 17-fold variation in signal. The geometry of the sample itself appears to be of prime importance for determining the strength of the response. We find that the reference phantom provided by the manufacturer is inadequate for calibration and is unable to detect the 10% variation over time of the signal of the apparatus. Until these problems are resolved, the usefulness of the EM-SCAN SA-2 to investigate body composition accurately is questionable.

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Numerical studies of backscattering enhancement of electromagnetic waves from two-dimensional random rough surfaces with the forward-backward/novel spectral acceleration method.

The forward-backward method with a novel spectral acceleration algorithm (FB/NSA) has been shown to be a highly efficient O(Ntot) iterative method of moments, where Ntot is the total number of unknowns to be solved, for the computation of electromagnetic (EM) wave scattering from both one-dimensional and two-dimensional (2-D) rough surfaces. The efficiency of the method makes studies of backscattering enhancement from moderately rough impedance surfaces at large incident angles tractable. Variations in the characteristics of backscattering enhancement with incident angle, surface impedance, polarization, and surface statistics are investigated by use of the 2-D FB/NSA method combined with parallel computing techniques. The surfaces considered are Gaussian random processes with an isotropic Gaussian spectrum and root-mean-square surface heights and slopes ranging from 0.5 lambda to lambda and from 0.5 to 1.0, respectively, where lambda is the EM wavelength in free space. Incident angles ranging from normal incidence up to 70 degrees are considered in this study. It is found that backscattering enhancement depends strongly on all parameters of interest. America

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Temporally constrained ICA: an application to artifact rejection in electromagnetic brain signal analysis.

Independent component analysis (ICA) is a technique which extracts statistically independent components from a set of measured signals. The technique enjoys numerous applications in biomedical signal analysis in the literature, especially in the analysis of electromagnetic (EM) brain signals. Standard implementations of ICA are restrictive mainly due to the square mixing assumption-for signal recordings which have large numbers of channels, the large number of resulting extracted sources makes the subsequent analysis laborious and highly subjective. There are many instances in neurophysiological analysis where there is strong a priori information about the signals being sought; temporally constrained ICA (cICA) can extract signals that are statistically independent, yet which are constrained to be similar to some reference signal which can incorporate such a priori information. We demonstrate this method on a synthetic dataset and on a number of artifactual waveforms identified in multichannel recordings of EEG and MEG. cICA repeatedly converges to the desired component within a few iterations and subjective analysis shows the waveforms to be of the expected morphologies and with realistic spatial distributions. This paper shows that cICA can be applied with great success to EM brain signal analysis, with an initial application in automating artifact extraction in EEG and MEG.

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An expectation-maximization-likelihood-ratio test for handling missing data: application in experimental crosses.

The mapping of quantitative trait loci (QTL) is an important research question in animal and human studies. Missing data are common in such study settings, and ignoring such missing data may result in biased estimates of the genotypic effect and thus may eventually lead to errant results and incorrect inferences. In this article, we developed an expectation-maximization (EM)-likelihood-ratio test (LRT) in QTL mapping. Simulation studies based on two different types of phylogenetic models revealed that the EM-LRT, a statistical technique that uses EM-based parameter estimates in the presence of missing data, offers a greater statistical power compared with the ordinary analysis-of-variance (ANOVA)-based test, which discards incomplete data. We applied both the EM-LRT and the ANOVA-based test in a real data set collected from F2 intercross studies of inbred mouse strains. It was found that the EM-LRT makes an optimal use of the observed data and its advantages over the ANOVA F-test are more pronounced when more missing data are present. The EM-LRT method may have important implications in QTL mapping in experimental crosses.

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Algorithmic approaches for computing elementary modes in large biochemical reaction networks.

The concept of elementary (flux) modes provides a rigorous description of pathways in metabolic networks and proved to be valuable in a number of applications. However, the computation of elementary modes is a hard computational task that gave rise to several variants of algorithms during the last years. This work brings substantial progresses to this issue. The authors start with a brief review of results obtained from previous work regarding (a) a unified framework for elementary-mode computation, (b) network compression and redundancy removal and (c) the binary approach by which elementary modes are determined as binary patterns reducing the memory demand drastically without loss of speed. Then the authors will address herein further issues. First, a new way to perform the elementarity tests required during the computation of elementary modes which empirically improves significantly the computation time in large networks is proposed. Second, a method to compute only those elementary modes where certain reactions are involved is derived. Relying on this method, a promising approach for computing EMs in a completely distributed manner by decomposing the full problem in arbitrarity many sub-tasks is presented. The new methods have been implemented in the freely available software tools FluxAnalyzer and Metatool and benchmark tests in realistic networks emphasise the potential of our proposed algorithms.

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Characterization of ordered-subsets expectation maximization with 3D post-reconstruction Gauss filtering and comparison with filtered backprojection in 99mTc SPECT.

PURPOSE: To characterize ordered-subset expectation maximization algorithm with a fixed 3D Gauss post-reconstruction filtering (OSEM) in 99mTc SPECT as for noise, contrast and spatial resolution with varying number of subset and iteration and to compare OSEM with an optimized set of parameters, with filtered backprojection (FBP) with filter parameters typical of brain and myocardial SPECT, both with and without Chang's method of attenuation correction (AC). METHODS: SPECT images of a Jaszczak phantom with cold rod inserts, hot and cold spheres and capillary line sources were acquired. Different background activity concentrations of the phantom were simulated as well as different lesion-to-background activity ratios. OSEM reconstructions were halted after 5, 10 and 15 iterations using 4, 8 and 16 subsets. RESULTS: The effect of subset and iteration number over noise is additive: thus, it is possible to define an EM-equivalent iteration number that indicates the product between the subset and the iteration numbers. Noise increases linearly with increasing EM-equivalent iteration number. For each level of nominal contrast, the measured contrast after OSEM shows a little increase with increasing iteration number and saturates after 80 EM-equivalent iterations. The application of AC leads to diminished contrast values both in FBP and OSEM. The contrast of cold lesions after OSEM increases with increasing number of EM-equivalent iteration number: after 80 iterations the contrast values with OSEM overtake the ones obtained with FBP; contrast values diminished as background concentration raised. Resolution values did not change with increasing EM-equivalent iteration number and were higher than those obtained with FBP. CONCLUSION: The major findings of the present work are the demonstration of additivity of subset and iteration in OSEM over noise, with the possibility of defining an EM equivalent iteration number, and the superiority of OSEM with respect to FBP in terms of spatial resolution.

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Subset-dependent relaxation in block-iterative algorithms for image reconstruction in emission tomography.

This paper presents a row-action maximum likelihood algorithm (RAMLA), in which the relaxation parameter is controlled in such a way that the noise propagation from projection data to the reconstructed image is substantially independent of the access order of the input data (subsets) in each cycle of the sub-iterations. The 'subset-dependent' relaxation parameter lambda(k) (q) is expressed as lambda(k)(q) = beta0/(beta0 + q + gamma k M), where M is the number of angular views, q (0 < or = q < or = M - 1) is the access order of the angular view, k is the iteration number and beta0 and gamma are constants. The constant beta0 deals with the balance of the noise propagation and the constant gamma controls the convergence of iterations. The value of beta0 is determined from the geometrical correlation coefficients among lines of coincidence response. The proposed RAMLA using the subset-dependent (dynamic) relaxation 'dynamic RAMLA (DRAMA)' provides a reasonable signal-to-noise ratio with a satisfactory spatial resolution by a few iterations in the two-dimensional image reconstruction for PET. Dynamic OS-EM (DOSEM) has also been developed, which allows the use of a larger number of subsets (OS level) Msub without loss of signal-to-noise ratio as compared to the conventional OS-EM. DRAMA is a special case of DOSEM, where Msub = M, and it is no more profitable to use DOSEM with a smaller Msub (< M), because DRAMA provides similar performance with the fastest convergence and smallest computer burden. This paper describes the theory, algorithm and the results of the simulation studies on the performance of DRAMA and DOSEM.

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Cyclops: new modular software suite for cryo-EM.

Cyclops is a new computer program designed as a graphical front-end that allows easy control and interaction with tasks and programs for 3D reconstruction of biological complexes using cryo-electron microscopy. Cyclops' current plug-ins are designed for automated particle picking and include two new algorithms, automated carbon masking and quaternion based rotation space sampling, which are also presented here. Additional plug-ins are in the pipeline. Cyclops allows straightforward organization and visualization of all data and tasks and allows both interactive and batch-wise processing. Furthermore, it was designed for straightforward implementation in grid architectures. As a front-end to a collection of programs it provides a common interface to these programs, thus enhancing the usability of the suite and the productivity of the user.

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Unsupervised classification of single particles by cluster tracking in multi-dimensional space.

In cryo-electron microscopy (cryo-EM) single-particle reconstruction, the heterogeneity of two-dimensional projection image data resulting from the co-existence of different conformational or ligand binding states of a macromolecular complex remains a major obstacle as it impairs the validity of reconstructed density maps and limits the progress toward higher resolution. Classification of cryo-EM data according to the different conformations is difficult because of the coexistence of multiple orientations in a single dataset. Here, we present an unsupervised classification method, termed cluster tracking, which utilizes the continuity in multi-dimensional space induced by angular adjacency of projections in large datasets. In a proof of concept, the testing of cluster tracking on simulated projection data, which were generated from multiple conformations and orientations of an existing volume, produced clusters that are consistent with the conformational identity of the data. The application of the method to experimental cryo-EM projection data is found to result in a partition similar to the one generated by supervised classification.

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Eliminating errors in emergency medical services: realities and recommendations.

Errors in health care can have serious consequences, not only for patients but for society as a whole, given the considerable national expenditures required to address these errors. Because of the number of patients treated and the acuity of emergency situations, eliminating errors should be a priority in emergency medical services (EMS) systems. In a recent report, the Institute of Medicine called for improvements in patient safety, which it defined as freedom from accidental injury. Recent efforts have focused on integrating EMS systems into error analyses of the total health care system. However, EMS systems must take the initiative in addressing their own major error-prone areas using the best and most current data available. Unfortunately, addressing the problem of medical errors in EMS systems still suffers from a paucity of data, owing to a lack of organized, funded programs backed by legislation and dedicated government coordination. We recommend that EMS medical directors consider specific error audits to decrease sources of errors and to be better able to identify EMS providers who would benefit from retraining. Error audits might first be focused on the following potentially serious errors: equipment malfunction, failure to check oxygen saturation, failure to immobilize the patient, use of incorrect protocol or algorithm, failure to check glucose levels, failure to recognize patient deterioration, failure to detect misplaced endotracheal tubes, and use of wrong drug or drug dose.

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Estimating generating partitions of chaotic systems by unstable periodic orbits

An outstanding problem in chaotic dynamics is to specify generating partitions for symbolic dynamics in dimensions larger than 1. It has been known that the infinite number of unstable periodic orbits embedded in the chaotic invariant set provides sufficient information for estimating the generating partition. Here we present a general, dimension-independent, and efficient approach for this task based on optimizing a set of proximity functions defined with respect to periodic orbits. Our algorithm allows us to obtain the approximate location of the generating partition for the Ikeda-Hammel-Jones-Moloney map.

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ADP_EM: fast exhaustive multi-resolution docking for high-throughput coverage.

MOTIVATION: Efficient fitting tools are needed to take advantage of a fast growth of atomic models of protein domains from crystallography or comparative modeling, and low-resolution density maps of larger molecular assemblies. Here, we report a novel fitting algorithm for the exhaustive and fast overlay of partial high-resolution models into a low-resolution density map. The method incorporates a fast rotational search based on spherical harmonics (SH) combined with a simple translational scanning. RESULTS: This novel combination makes it possible to accurately dock atomic structures into low-resolution electron-density maps in times ranging from seconds to a few minutes. The high-efficiency achieved with simulated and experimental test cases preserves the exhaustiveness needed in these heterogeneous-resolution merging tools. The results demonstrate its efficiency, robustness and high-throughput coverage. AVAILABILITY: http://sbg.cib.csic.es/Software/ADP_EM. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

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Quantum filtering and discrimination between sets of Boolean functions.

In quantum state filtering one wants to determine whether an unknown quantum state, which is chosen from a known set of states, [|psi(1)>, em leader,|psi(N)>], is either a specific state, say |psi(1)>, or one of the remaining states, [|psi(2)>, em leader,|psi(N)>]. We present the optimal solution to this problem, in terms of generalized measurements, for the case that the filtering is required to be unambiguous. As an application, we propose an efficient, probabilistic quantum algorithm for distinguishing between sets of Boolean functions, which is a generalization of the Deutsch-Jozsa algorithm.

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