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PubMedDate not supplied

Accuracy of frozen section in diagnosis of ovarian mass.

To determine the accuracy of frozen section according to the status of malignancy and the histologic cell type, we reviewed the frozen and permanent pathologic reports of 212 resected ovarian masses in our hospital. The accuracy, sensitivity, specificity, positive, and negative predictive value of frozen section were studied. The overall accuracy to determine the status of malignancy was 90.9%. Sensitivity of the test was highest in the benign groups at 99.1% and lowest in the borderline groups at 50%. All inaccurate diagnoses were in the common epithelial groups. Problems in diagnosis of mucinous tumors and borderline tumors were striking. The accuracy of the test for histologic diagnosis was 91.9%. Most cases of the incorrect diagnosis (81.3%) were common epithelial tumors. In conclusion, the accuracy of frozen section in the diagnosis of ovarian mass was generally high with a few exceptions in large tumors, mucinous, or borderline tumors that yielded lower accuracy, sensitivity, specificity, and positive predictive value. We encourage both the surgeons and the pathologists to be cautious of these limitations. Additional number of frozen section taken for a mass larger than 10 cm may minimize the error in large tumors to some extent.

Adenocarcinoma, Mucinous↗

PubMed1986

Preferential looking as a measure of visual resolution in infants and toddlers: a comparison of psychophysical methods.

We used preferential looking to estimate the monocular visual resolution of children 6-36 months old and compared results from 3 psychophysical methods: Taylor and Creelman's PEST staircase, our modification of the PEST procedure, and the method-of-constant stimuli. Estimates of visual resolution for 48 children tested with the original and modified PEST procedures and for 50 children tested with the method-of-constant stimuli and the modified PEST procedure showed excellent agreement across procedures, with the modified PEST procedure requiring the fewest trials and the least time. Results from the modified PEST procedure for 168 children with normal eye alignment and minimal refractive errors indicated that monocular visual resolution improves from 6.5 min at 6 months to 1.2 min at 36 months. Preferential looking combined with the shortened PEST procedure should be useful for testing the visual resolution of preverbal children with eye problems.

Child Development↗

PubMed2005

Accuracy of intraoperative retinoscopy in corneal power and axial length estimation using a high plus soft contact lens.

AIM: To assess the accuracy of intraoperative retinoscopy with high plus soft contact lens (CL) in estimating corneal power and the axial length compared with standard keratometry and biometry measurement. METHODS: Intraoperative retinoscopy was performed in 30 eyes prior to the implantation of an intraocular lens (IOL). A +10 D disposable soft contact lens was applied on the cornea to minimize retinoscopic error. Corneal power was derived from refraction using biometric axial length while the axial length was derived using keratometric measurement. Refraction derived corneal powers and axial lengths from 26 eyes within +/-1.00 D of the target postoperative refraction were compared with preoperative standard keratometry and biometry measurements. RESULTS: In the 26 eyes, the mean difference between the corneal powers derived from refraction and keratometry was 0.35 D (S.D.=1.678). The 95% limits of agreement were -3.006 to +3.706. The mean difference between the axial lengths derived from refraction and biometry was 0.15 mm (S.D.=0.721). The 95% limits of agreement were -1.292 to 1.542. CONCLUSION: Intraoperative retinoscopy with a high plus soft contact lens after phacoemulsification is useful but not accurate in estimating corneal power or axial length of the eye. It should be used cautiously in IOL power calculation as a substitute for standard keratometry or biometry machines when either of these is not available or in error.

Aged↗

PubMed1977

Gas chromatographic on-column methylation technique for the simulataneous determination of antiepileptic drugs in blood.

An on-column methylation technique (OCMT) is described for the simultaneous, gas chromatographic determination in blood of ethosuximide (ES), phenobarbital (PB), primidone (PD), phenytoin (DPH), and 5-ethyl-5-phenylhydantoin (EPH). Multiple internal standards are employed in the OCMT, in order to eliminate or to minimize greatly error sources common to the technology of gas chromatography and to compensate for the different chemical dispositions of the antiepileptic drugs in an OCMT. The internal standards used in the OCMT were as follows: alpha,alpha,beta-trimethylsuccinimide (TMS) was used for the determination of ES; 5-ethyl-5-para-tolylbarbituric acid (MPB), for PB; 5-ethyl-5-(para-tolyl) hexahydropyrimidine-4,6-dione (MPD), for PD; and 5-(para-tolyl)-5-phenylhydantoin (MPPH), for EPH and DPH. The use of ether, the buffering of the plasma sample at pH 7.6, and the use of dilute (0.30-0.35 M) trimethyl-phenylammonium hydroxide (TMPAH) contributed to the specificity of the extraction scheme of the OCMT. The precision and accuracy of the OCMT was attributed to the use of appropriate, multiple internal standards. A method is described for the preparation of standard solutions of drugs in blank plasma (biological matrix) and for the use of the standards in calibration and daily intra-laboratory control of the OCMT.

Anticonvulsants↗

PubMed2002

The emerging imperative for health care quality improvement.

There are widespread and growing concerns about the variable and too often inadequate quality of health care in the United States. As a result, health care quality is being questioned and subjected to scrutiny as never before. Awareness of the quality deficits, combined with rising health care expenditures and changing attitudes of payers and consumers, has given rise to a nascent but growing quality improvement movement. Multiple barriers must be surmounted by this movement, but substantive work is under way on all fronts. Emergency medicine will definitely be affected by the quality improvement movement and should quickly move forward to define and establish performance measures for high-quality emergency care in an era when chronic disease dominates the agenda. Emergency medicine should also aggressively work to operationalize a culture of quality to minimize medical errors, to practice evidence-based medicine, to translate research results into clinical practice in a timely manner, and to establish accountability mechanisms for quality improvement and clinical excellence.

Emergency Medicine↗

PubMed2004

Axially symmetric semi-infinite domain models of microdialysis and their application to the determination of nutritive flow in rat muscle.

Theoretical models for the description of microdialysis outflow:inflow (O/I) ratio for 3H2O and [14C]ethanol were developed, taking into account the nutritive fraction of total blood flow in muscle. The models yielded an approximately exponential decay expression for the O/I ratio, dependent on the physical dimensions of a linear probe (length and radius), the flow rate through the probe, muscle blood flow (including the nutritive fraction) and the diffusion coefficients for the tracer in the probe and muscle. The models compared favourably with experimental data from the constant-flow perfused rat hindlimb. Estimates of the nutritive fraction of total blood flow from experimental data were determined by minimizing the error between model and experimental data. The nutritive fraction was found to be 0.22 +/- 0.04 under basal perfusion conditions. When 70 nM noradrenaline (norepinephrine) was included in the perfusion medium, the nutritive fraction was 0.91 +/- 0.06 (P < 0.05). The inclusion of 300 nM serotonin, decreased the nutritive fraction to 0.05 +/- 0.01 (P < 0.05). This model can be applied to the determination of nutritive fraction of skeletal muscle blood flow in physiologically relevant microvascular conditions such as during exercise and in disease states.

Animals↗

PubMed2006

Sensitivities of medial meniscal motion and deformation to material properties of articular cartilage, meniscus and meniscal attachments using design of experiments methods.

This study investigated the role of the material properties assumed for articular cartilage, meniscus and meniscal attachments on the fit of a finite element model (FEM) to experimental data for meniscal motion and deformation due to an anterior tibial loading of 45 N in the anterior cruciate ligament-deficient knee. Taguchi style L18 orthogonal arrays were used to identify the most significant factors for further examination. A central composite design was then employed to develop a mathematical model for predicting the fit of the FEM to the experimental data as a function of the material properties and to identify the material property selections that optimize the fit. The cartilage was modeled as isotropic elastic material, the meniscus was modeled as transversely isotropic elastic material, and meniscal horn and the peripheral attachments were modeled as noncompressive and nonlinear in tension spring elements. The ability of the FEM to reproduce the experimentally measured meniscal motion and deformation was most strongly dependent on the initial strain of the meniscal horn attachments (epsilon(1H)), the linear modulus of the meniscal peripheral attachments (E(P)) and the ratio of meniscal moduli in the circumferential and transverse directions (E(theta)E(R)). Our study also successfully identified values for these critical material properties (epsilon(1H) = -5%, E(P) = 5.6 MPa, E(theta)E(R) = 20) to minimize the error in the FEM analysis of experimental results. This study illustrates the most important material properties for future experimental studies, and suggests that modeling work of meniscus, while retaining transverse isotropy, should also focus on the potential influence of nonlinear properties and inhomogeneity.

Aged↗

PubMed2006

The deformation of an erythrocyte under the radiation pressure by optical stretch.

In this paper, the mechanical properties of erythrocytes were studied numerically based upon the mechanical model originally developed by Pamplona and Calladine (ASME J. Biomech. Eng., 115, p. 149, 1993) for liposomes. The case under study is the erythrocyte stretched by a pair of laser beams in opposite directions within buffer solutions. The study aims to elucidate the effect of radiation pressure from the optical laser because up to now little is known about its influence on the cell deformation. Following an earlier study by Guck et al. (Phys. Rev. Lett., 84, p. 5451, 2000; Biophys. J., 81, p. 767, 2001), the empirical results of the radiation pressure were introduced and imposed on the cell surface to simulate the real experimental situation. In addition, an algorithm is specially designed to implement the simulation. For better understanding of the radiation pressure on the cell deformation, a large number of simulations were conducted for different properties of cell membrane. Results are first discussed parametrically and then evaluated by comparing with the experimental data reported by Guck et al. An optimization approach through minimizing the errors between experimental and numerical data is used to determine the optimal values of membrane properties. The results showed that an average shear stiffness around 4.611x10-6 Nm(-1), when the nondimensional ratio of shear modulus to bending modulus ranges from 10 to 300. These values are in a good agreement with those reported in literature.

Cell Size↗

PubMed1995

Axial strain measurements in skeletal muscle at various strain rates.

A noncontact optical system using high speed image analysis to measure local tissue deformations and axial strains along skeletal muscle is described. The spatial resolution of the system was 20 pixels/cm and the accuracy was +/- 0.125 mm. In order to minimize the error associated with discrete data used to characterize a continuous strain field, the displacement data were fitted with a third order polynomial and the fitted data differentiated to measure surface strains using a Lagrangian finite strain formulation. The distribution of axial strain along the muscle-tendon unit was nonuniform and rate dependent. Despite a variation in local strain distribution with strain rate, the maximum axial strain, Exx = 0.614 +/- 0.045 mm/mm, was rate insensitive and occurred at the failure site for all tests. The frequency response of the video system (1000 Hz) and the measurement of a continuous strain field along the entire length of the structure improve upon previous noncontact optical systems for measurement of surface strains in soft tissues.

Animals↗

PubMed1999

Optimization algorithm performance in determining optimal controls in human movement analyses.

The objective of this study was to evaluate the performance of different multivariate optimization algorithms by solving a "tracking" problem using a forward dynamic model of pedaling. The tracking problem was defined as solving for the muscle controls (muscle stimulation onset, offset, and magnitude) that minimized the error between experimentally collected kinetic and kinematic data and the simulation results of pedaling at 90 rpm and 250 W. Three different algorithms were evaluated: a downhill simplex method, a gradient-based sequential quadratic programming algorithm, and a simulated annealing global optimization routine. The results showed that the simulated annealing algorithm performed for superior to the conventional routines by converging more rapidly and avoiding local minima.

Algorithms↗

PubMed1993

In vitro evaluation of an implantable force transducer (IFT) in a patellar tendon model.

A new implantable transducer has been developed for in situ evaluation of ligament and tendon forces. Unlike previous devices, this sensor is placed within the specimen, minimizing measurement errors due to impingement on surrounding soft tissues and bone. In this study, we present the sensor design details as well as test results from initial in vitro trials in the goat patellar tendon model. Device performance and influence of the device on the specimen were evaluated under several loading conditions. In all cases, device output had a strong correlation with induced tissue load. Significant variations in device performance were only noted at high tissue deformation rates. More extensive investigations will be conducted to assess how changes in transducer design might alter performance characteristics.

Animals↗

PubMed1994

Derivation of shear rates from near-wall LDA measurements under steady and pulsatile flow conditions.

Atherosclerosis, thrombosis, and intimal hyperplasia are major forms of cardiovascular diseases in the United States. Previous studies indicate a significant correlation between hemodynamics, in particular, wall shear rate, and pathology of the arterial walls. While results of these studies implicate morphologic and functional changes related to wall shear rate magnitude, a standard technique for wall shear rate measurement has not been established. In this study, theoretical and in-vitro experimental fully developed steady and physiologic pulsatile flow waveforms have been used to obtain velocity profiles in the near-wall region. The estimated wall shear rates from these results are compared to the theoretical value to assess the accuracy of the approximating technique. Experimentally obtained results from LDA suggest that in order to minimize the error in velocity data, and subsequently, the wall shear rate, the first measured velocity has to be 500 microns away from the wall. While a linear approximation did not produce errors larger than 16.4 percent at peak systole, these errors substantially increased as the velocity magnitudes decreased during late systole and diastole. Overall, a third degree polynomial curve fit using four points produced the most accurate estimation of wall shear rate through out the cardiac cycle. Results of higher degree curve-fitting functions can be unpredictable due to potential oscillations of the function near the wall. Hence, based on the results of this study, use of a linear approximation is not recommended; a third degree curve-fitting polynomial, using four points provided the most accurate approximation for these flow waveforms.

Bias↗

PubMed1983

A direct substitution, equation error technique for solving the thermographic tomography problem.

A new technique for solving the combined state and parameter estimation problem in thermographic tomography is presented. The technique involves the direct substitution of known skin temperatures into the finite difference form of the bio-heat transfer equation as formulated for solving an initial value problem with a convection boundary condition at the skin surface. These equations are then used to solve the inverse bio-heat transfer problem for the unknown subcutaneous tissue temperatures and physiological parameters. For a small number of nodal points, closed form algebraic solutions are obtained. For larger sets of equations, a hybrid technique is used in which the problem is initially posed as an unconstrained optimization problem in which the model equation error is minimized using the conjugate gradient descent technique to get close to a solution. Then a generalized Newton-Raphson technique was used to solve the equations. A numerical simulation of a one-dimensional problem is investigated both with and without noise superimposed on the input (transient) skin temperature data. The results show that the technique gives very accurate results if the skin temperature data contains little noise. It is also shown that if the physical properties of the tissue and the metabolism are known, that a given set of proper transient skin temperature inputs yields a unique solution for the unknown internal temperatures and blood perfusion rates. However, the similar problem with known blood perfusion rates and unknown metabolisms does not yield a unique solution for the internal temperatures and metabolisms.

Biomechanical Phenomena↗

PubMed2001

A measured data set for evaluating electron-beam dose algorithms.

The purpose of this work was to develop an electron-beam dose algorithm verification data set of high precision and accuracy. Phantom geometries and treatment-beam configurations used in this study were similar to those in a subset of the verification data set produced by the Electron Collaborative Working Group (ECWG). Measurement techniques and quality-control measures were utilized in developing the data set to minimize systematic errors inherent in the ECWG data set. All measurements were made in water with p-type diode detectors and using a Wellhöfer dosimetry system. The 9 and 20 MeV, 15 x 15 cm2 beams from a single linear accelerator composed the treatment beams. Measurements were made in water at 100 and 110 cm source-to-surface distances. Irregular surface measurements included a "stepped surface" and a "nose-shaped surface." Internal heterogeneity measurements were made for bone and air cavities in differing orientations. Confidence in the accuracy of the measured data set was reinforced by a comparison with Monte Carlo (MC)-calculated dose distributions. The MC-calculated dose distributions were generated using the OMEGA/BEAM code to explicitly model the accelerator and phantom geometries of the measured data set. The precision of the measured data, estimated from multiple measurements, was better than 0.5% in regions of low-dose gradients. In general, the agreement between the measured data and the MC-calculated data was within 2%. The quality of the data set was superior to that of the ECWG data set, and should allow for a more accurate evaluation of an electron beam dose algorithm. The data set will be made publicly available from the Department of Radiation Physics at The University of Texas M. D. Anderson Cancer Center.

Algorithms↗

PubMed2003

A quality assurance method for analyzing and verifying intensity modulated fields.

A quality assurance method is developed for measuring, verifying and analyzing intensity modulated radiation fields. It is applicable for rotational and fixed-beam intensity modulated radiation therapy (IMRT) treatments. A gantry-mount device was constructed to measure the transmission dose of an IMRT field using radiographic films. A double-exposure technique with optimal kernel estimate method was developed to minimize the errors from measurements. A chi2 confidence level test method was developed to detect the discrepancies between measured and prescribed IMRT fluence distributions. Our method was tested for rotational and fixed-beam IMRT treatment verifications. The method was found insensitive to the hardware-related parameters for rotational and fixed-beam IMRT deliveries. The chi2 confidence level test was found to be more sensitive than linear correlation method in detecting relative small errors for cases with a few segments or narrow regions of interest. In conclusion, we demonstrated a quantitative method for verifying and analyzing IMRT treatment deliveries.

Models, Statistical↗

PubMedDate not supplied

The direct determination of dose-to-water using a water calorimeter.

A flexible, temperature-regulated, water calorimeter has been constructed which consists of three nested cylinders. The innermost "core" is a 10 X 10 cm right cylinder made of glass, the contents of which are isolated from the environment. It has two Teflon-washered glass valves for filling, and two thermistors are supported at the center by glass capillary tubes. Surrounding the core is a "jacket" that provides approximately 2 cm of air insulation between the core and the "shield." The shield surrounds the jacket with a 2.5-cm layer of temperature-regulated water flowing at 51/min. The core is filled with highly purified water the gas content of which is established prior to filling. Convection currents, which may be induced by dose gradients or thermistor power dissipation, are eliminated by operating the calorimeter at 4 degrees C. Depending upon the power level of the thermistors, 15-200 microW, and the insulation provided by the glass capillary tubing, the temperature of the thermistors is higher than that of the surrounding water. To minimize potential errors caused by differences between calibration curves obtained at finite power levels, the zero-power-level calibration curve obtained by extrapolation is employed. Also the calorimeter response is corrected for the change in power level, and therefore thermistor temperature, that follows the resistance change caused by irradiation. The response of the calorimeter to 4-MV x rays has been compared to that of an ionization chamber irradiated in an identical geometry.(ABSTRACT TRUNCATED AT 250 WORDS)

Calorimetry↗

PubMed1999

Image de-noising by integer wavelet transforms and generalized cross validation.

De-noising algorithms based on wavelet thresholding replace small wavelet coefficients by zero and keep or shrink the coefficients with absolute value above the threshold. The optimal threshold minimizes the error of the result as compared to the unknown, exact data. To estimate this optimal threshold, we use Generalized Cross Validation. This procedure has linear complexity and is fully automatic, i.e., it does not require an estimate for the noise energy. This paper uses the method for wavelet transforms that map integer gray-scale pixel values to integer wavelet coefficients. An image with artificial noise is used to illustrate the optimality properties of the estimator. Not all theoretical requirements for a successful application of the method are strictly fulfilled in the integer transform case. However, this has little influence on practical results.

Algorithms↗

PubMed2005

Target localization for post-prostatectomy patients using CT and ultrasound image guidance.

We conducted a study comparing B-mode acquisition and targeting (BAT) ultrasound alignments based on CT data in the postoperative setting. CT scans were obtained with a Primatom CT-on-rails on nine patients. Two CT scans were obtained each week, while setup error was minimized by BAT ultrasounds. For the first three patients, a direct comparison was performed. For the next six patients, a template based on the shifts from the week 1 CT during treatment was used for subsequent setup. Comparison of isocenter shifts between the BAT ultrasound and CT was made by the difference, absolute difference, and improvement (using CT alignments as the reference technique). A total of 90 image comparisons were made. The average interfraction motion was 3.2 mm in the lateral, 3.0 mm in the longitudinal, and 5.1 mm in the AP direction. The results suggest that the CTbased ultrasound templates can improve the localization of the prostate bed when the initial displacements are greater than 4 mm. For initial displacements smaller than 4 mm, the technique neither improved nor worsened target localization. However, ultrasound alignments performed without the use of a template deteriorated patient positioning for two out of three patients, demonstrating that the use of a CT template was beneficial even at small initial displacements.

Humans↗