Background: Maximum safe resection of infiltrative brain tumors in eloquent area is the primary objective in surgical neuro-oncology. This goal can be achieved with direct electrical stimulation to perform a functional mapping of the brain in patients awake intraoperatively. When awake surgery is not possible, we propose a pipeline procedure that combines advanced techniques aiming at performing a dissection that respects the anatomo-functional connectivity of the peritumoral region. This procedure can benefit from intraoperative monitoring with computerized tomography scan and brain (...) shift correction. Associated with this intraoperative monitoring, the additional value of preoperative investigation combining brain mapping by navigated transcranial magnetic stimulation with various neuroimaging modalities has not yet been reported.Case Report: A 42-year-old left-handed man had increased intracranial pressure, left hand muscle deficit, and dysarthria, related to an infiltrative tumor of the right frontal lobe with large mass effect and circumscribed contrast enhancement in motor and premotor cortical areas. Spectroscopy profile and intratumoral calcifications on CT-scan suggested an WHO grade III glioma, later confirmed by histology. The aforementioned surgical procedure was considered, since standard awake surgery was not appropriate for this patient. In preoperative time, nTMS mapping of motor function was performed, combined with magnetic resonance imaging -based tractography reconstruction of 6 neural tracts and resting-state functional MRI connectivity of sensorimotor and language networks. In intraoperative time, DES mapping was performed with motor evoked response recording and tumor resection was optimized using non-rigid image transformation of the preoperative data to iCT data. Image guidance was updated with correction for brain shift and tissue deformation using biomechanical modeling taking into account brain elastic properties. This correction was done at crucial surgical steps, i.e., when tumor bulged through the craniotomy after dura mater opening and when approaching the presumed eloquent brain regions. This procedure allowed a total resection of the tumor region with contrast enhancement as well as a complete regression of IICP and dysarthria. Hand paresis remained stable with no additional deficit. Postoperative nTMS mapping confirmed the good functional outcome.Conclusion: This case report and technical note highlights the value of preoperative functional evaluation by nTMS updated intraoperatively with correction of brain deformation by iCT. This multimodal approach may become the optimized technique of reference for patients with brain tumors in eloquent areas that are unsuitable for awake brain surgery. (shrink)

Scanning the Pharaohs: CT Imaging of the New Kingdom Royal Mummies. By Zahi Hawass and Sahar N. Saleem. Cairo: The American University in Cairo Press, 2016. Pp. xviii + 318, illus. $59.95.

The proposed work describes an approach for the segmentation of abnormal lung CT scans of COVID-19. Lung diseases are the leading killer in both men and women. The pulmonary experts normally make attempts, such as early detection of patients by tomography tests before lung specialists treat patients who are tortured by lung disease. Moreover, lung specialists do their best to detect the presence of lung conditions. X rays or CT scan checks are performed for tomography tests. The finest approach (...) for medical diagnosis and a wide range of uses is computed tomography. This kind of imaging offers elaborate cross-sectional pictures of skinny slices of the organic structure. However, the preprocessing and denoising methods of Lung CT scans may mask some important image features. To address this challenge, we propose a novel framework involving an optimization technique algorithm to solve a multilevel thresholding problem based on information theory to segment abnormal lung CT scans. The proposed framework will evaluate a sample of CT scan images taken from a well-known benchmark database. The evaluation results will assess subjectively and objectively to demonstrate the effectiveness of the proposed framework. (shrink)

The ongoing coronavirus 2019 pandemic caused by the severe acute respiratory syndrome coronavirus 2 has resulted in a severe ramification on the global healthcare system, principally because of its easy transmission and the extended period of the virus survival on contaminated surfaces. With the advances in computer-aided diagnosis and artificial intelligence, this paper presents the application of deep learning and adversarial network for the automatic identification of COVID-19 pneumonia in computed tomography scans of the lungs. The complexity and time (...) limitation of the reverse transcription-polymerase chain reaction swab test makes it disadvantageous to depend solely on as COVID-19’s central diagnostic mechanism. Since CT imaging systems are of low cost and widely available, we demonstrate that the drawback of the RT-PCR can be alleviated with a faster, automated, and reduced contact diagnostic process via the use of a neural network model for the classification of infected and noninfected CT scans. In our proposed model, we explore the benefit of transfer learning as a means of resolving the problem of inadequate dataset and the importance of semisupervised generative adversarial network for the extraction of well-mapped features and generation of image data. Our experimental evaluation indicates that the proposed semisupervised model achieves reliable classification, taking advantage of the reflective loss distance between the real data sample space and the generated data. (shrink)

The laser scanning confocal microscope (LSCM)LSCM: laser scanning confocal microscope; FISH: fluorescence in situ hybridisation; DiO6: 3,3′‐dihexyloxacarbocyanine iodide; NBD‐ceramide: 6‐((N‐(7‐nitrobenz‐2‐oxa‐1,3‐diazol‐4‐yl)amino)‐caproyl)sphingosine; DiO: 3,3′‐dioctadecyloxacarbocyanine perchlorate; DiI: 1,1′‐dioctadecyl‐3,3,3′,3′‐tetramethyl‐indocarbocyanine perchlorate; CCD: charge‐coupled device; DIC: differential interference contrast; FURA2: (‐(2‐(5‐carboxyoxazol‐2‐yl)‐6‐aminobenzofuran‐5‐oxy)‐2‐)2′‐amino‐5′‐methylphenoxy)‐ethane‐N,N,N′,N′‐ tetraacetic acid, sodium salt);BCECF: 2′,7′‐bis‐(carboxyethyl)‐5‐(and‐6‐)‐carboxyfluorescein;fluo‐3: 1‐(2‐amino‐5‐(2,7‐dichloro‐6‐hydroxy‐3‐oxo‐3H‐xanthen‐9‐yl)‐2‐(2′amino‐5′‐methylphenoxy)‐ethane‐N,N, N′,N′,‐tetraacetic acid, ammonium salt; DAPI: 4′,6‐diamidino‐2‐phenylindole, dihydrochloride; PET: positron emission tomogrophy; CT: computer‐assisted tomogrophy; CiD: cubitus interruptus dominus; MRC: Medical Research Council; TOTO‐1: benzothiazolium‐4‐quinolinium dimer; YOYO‐1: benzoxazolium‐4‐quinolinium dimer; ex.: excitation wavelength; em.: emission wavelength. is now established as an invaluable tool in (...) developmental biology for improved light microscope imaging of fluorescently labelled eggs, embryos and developing tissues. The universal application of the LSCM in biomedical research has stimulated improvements to the microscopes themselves and the synthesis of novel probes for imaging biological structures and physiological processes. Moreover the ability of the LSCM to produce an optical series in perfect register has made computer 3‐D reconstruction and analysis of light microscope images a practical option. (shrink)

New technologies can upset scientific workplaces’ established practices and social order. Scientists may therefore prefer preserving skilled manual work and the social status quo to revolutionary technological change. For example, digital imaging of rock-encased fossils is a valuable way for scientists to “see” a specimen without traditional rock removal. However, interviews in vertebrate paleontology laboratories reveal workers’ skepticism toward computed tomography imaging. Scientists criticize replacing physical fossils with digital images because, they say, images are more subjective than the “real thing.” (...) I argue that these scientists are also implicitly supporting rock-removal technicians, who are skilled and trusted experts whose work would be made obsolete by widespread implementation of CT scanning. Scientists’ view of CT as a sometimes useful tool rather than a universal new approach to accessing fossils preserves the laboratory community’s social structure. Specifically, by privileging “real” specimens and trusted specimen-processing technicians over images and imaging experts, scientists preserve the lab community’s division of labor and skill, hierarchy between scientists and technicians, and these groups’ identity and mutual trust. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Whisper Before You GoJohn K PettyDavid came with a bang.1A momentary prelude from a dysphonic chorus of pagers announce “Level 1 Pediatric Trauma—MVC ejected” before the abrupt crescendo of the trauma bay doors opening. He is maybe two. Maybe three–years–old. It is hard to tell when a child is strapped in, strapped down, nonverbal, intubated, and alone.The flight team speaks for him, “Four–year–old boy improperly restrained in a single–vehicle (...) crash into a ditch. He was partially ejected. He was unresponsive and pulseless at the scene. He got CPR and code drugs, and they got a pulse back. Emergency medical service (EMS) took him to the nearest hospital where they needled his chest, called for air transport, and scanned him up. He has been shocky for us since we picked him up. Glasgow Coma Scale (GCS) has been three the whole time. They said his head scan showed subarachnoid hemorrhage.”With the words of the flight team as background narrative, we get about doing our thing—hopefully more method and less madness. Bang, bang, bang! Check the tube. Vital signs. IV fluids. Place a chest tube. Hang the blood. Quick X–ray. Neuro exam—nothing. Get him off the board. Warm him up. Place the orogastric (OG) tube. Bang, bang, bang!The neurosurgery resident opens the CT scans from the other hospital. The brain and cervical spine scans show a disaster: some swelling and bleeding in the higher brain, but the worst damage is in the lower brain, brainstem, and top of the spinal cord. I have heard a neurosurgeon describe this pattern before as “internal decapitation.” Such language never makes it into the patient’s chart. For David the last two words of the neurosurgery consult note will eventually read, “Prognosis grim.”He remains unstable in the trauma bay. Inaction is death. We ultrasound his heart, abdomen, and pelvis. He has fluid that shouldn’t be around his heart. He is dying of the neuro injury we cannot control, but the pericardial fluid might be giving him shock, and we can control that. We can’t ignore the fluid. Shouldn’t ignore it. At least, wouldn’t ignore it. So, we bang up to the operating room. Squeezing blood. Spiking fluid. Oxygen tank and crash cart. Up we go.In the operating room, we do much and we do well. We release the fluid around the heart and find it was CPR, not heart injury that put it there. In the pericardial flash we get a view of the cardiac athlete, pounding like the 26th mile of the marathon. We explore the abdomen and find it swollen but innocent of an injury that would take his life. We place our lines and tubes as the neurosurgeons place theirs. If nothing else, we will be able to measure what lies ahead.“Good work, team,” and we bump the door on the way to the pediatric intensive care unit (PICU).The care in the PICU is more Apache brave than Gaelic knight—more bottles, fewer scissors. The curtains and carpets mute the tones. Our efforts continue, but I get a word that David’s father has arrived. He is sitting in a small, private waiting room off of the main PICU waiting room. The PICU staff colloquially refer to this as “the bad news room.” I take a seat next to a solitary man who is having the worst day of his life. His worst day so far.“I am Dr. Petty, and I am one of the doctors who is taking care of your son. I am very sorry about what has happened. Maybe you can tell me a little bit about what you understand is going on, and I’ll tell you what I know.” [End Page 17]He tells me that his wife was driving David back from her sister’s house, just the two of them. He doesn’t know what happened, but he got a call from the other hospital about the crash. His wife was badly hurt. He heard that David had died, but they got him back. Both were transferred up to the... (shrink)

Historically, the practice of medicine has been a physically intimate endeavor. Physicians have used their hands to palpate and reveal the secrets hidden within the body. Smelling the breath for the ketosis of diabetes or tasting the skin for the saltiness of cystic fibrosis were among the physician's essential practices. Today, perhaps the most defining characteristic of a brilliant clinician is the ability to synthesize many images—from electrocardiograms, ultrasounds, CT scans, and so forth—into a coherent picture that can guide (...) our diagnosis and treatment. Yet this is rapidly becoming a Sisyphean task. Just as we are about to drown in a deluge of data, AI is throwing us a life preserver, to save not only our patients but ourselves. But where will AI take us? (shrink)

Recording and manipulating neuronal ensemble activity is a key requirement in advanced neuromodulatory and behavior studies. Devices capable of both recording and manipulating neuronal activity brain-computer interfaces should ideally operate un-tethered and allow chronic longitudinal manipulations in the freely moving animal. In this study, we designed a new intracortical BCI feasible of telemetric recording and stimulating local gray and white matter of visual neural circuit after irradiation exposure. To increase the translational reliance, we put forward a Göttingen minipig model. The (...) animal was stereotactically irradiated at the level of the visual cortex upon defining the target by a fused cerebral MRI and CT scan. A fully implantable neural telemetry system consisting of a 64 channel intracortical multielectrode array, a telemetry capsule, and an inductive rechargeable battery was then implanted into the visual cortex to record and manipulate local field potentials, and multi-unit activity. We achieved a 3-month stability of the functionality of the un-tethered BCI in terms of telemetric radio-communication, inductive battery charging, and device biocompatibility for 3 months. Finally, we could reliably record the local signature of sub- and suprathreshold neuronal activity in the visual cortex with high bandwidth without complications. The ability to wireless induction charging combined with the entirely implantable design, the rather high recording bandwidth, and the ability to record and stimulate simultaneously put forward a wireless BCI capable of long-term un-tethered real-time communication for causal preclinical circuit-based closed-loop interventions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Night ShiftCalvin R. GrossI don't like working at night anymore. Too much goes wrong when you're alone.I'm sitting at my desk in the middle of the cardiac intensive care unit, and it's far later than I'd like to be awake—two or three in the morning. Things are calm, almost pleasant. I can hear the occasional alarm going off—an imperfectly positioned blood pressure cuff, a pulse oximeter with a poor (...) waveform, a ventilator with secretions in it. The night's initial frenzied work is done; my new admissions are tucked away, and my overnight to-dos are completed. Now it's just time to sit and wait. I could sleep, but despite the calm, I'm too afraid to leave the unit to rest. The fellow has gone to bed hours ago, and now it's just me. Sure, I'm surrounded by experienced nurses who know their work well, but somehow, I'm the one in charge. A brand-new second-year resident, the only doctor there. I'm no intern, that's for sure, but I've never led a code before, and I've only ever placed one central line without supervision. As second years go, I'm as fresh as they come.The daytime, you see, is far different than nights. There's a large (and even bloated) team of two attendings, two fellows, two pharmacists, and more importantly, multiple other residents. When you don't know what to do for a patient, there's always someone there to bounce ideas off of. When something difficult or surprising happens, there are peers and mentors to process with. At night, it's the opposite—no peers, no mentors, only a group of experienced nurses, whose circle is closed to me, the outsider. I long to be a part of that large and bloated daytime team."Can you come into 23? I think his pupils are a different size."I'm startled out of my thoughts. 23 … All I can remember from sign-out that evening is that he's young, close to my age, and supposedly stable. I look at my notes, a catalogue of tragedies: early onset heart failure, multiple prior suicide attempts, intubated because of pulmonary edema, and a left-ventricular assist device (LVAD) that's malfunctioning. I walk over to the room and look at the nurse at the other side of the bed. She's in the early phases of her career too—less than a year on the job—but she's still more experienced than me. I take a flashlight, open his eyelids, and look at the pupils. Sure enough, one of them is much larger than the other. When I shine the light into each eye, the large one doesn't change. When I turn his head from side to side, his eyes stay fixed. We look [End Page 83] at each other, she and I. We both know something terrible is happening."Should we maybe wake the fellow up?" she asks tentatively.I nod my head in agreement, glad to have been offered a suggestion. It's the right thing to do. I walk to the fellow's call room, knock on the door, and wake him up. He's set to work 24 hours and would like nothing more than to keep resting. He sleepily comes with me to the bedside, looks at the pupils as well, and says, "With the sedation on, your exam isn't going to be the most accurate. We should start by scanning his head, and then go from there. Wake me back up if you need me, but I know you've got this one."I don't think that I deserve the confidence he has in me. I walk back to my desk, open the patient's chart, and place the order for an urgent CT scan. The machinery of the hospital starts to rumble as the imaging schedulers find a spot in the queue for the scan, the patient's nurse and respiratory therapist disconnect and reconnect cables and tubes, the technicalities of the scan are ironed out, and he is... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:My Ability to FlourishPaulette KoehlerIn twenty years of convulsions, I’ve never heard a neurologist mention the word “epilepsy.” Over this time, the intensity of my original simple partial seizures, “simple” signifying retained consciousness and “partial” indicating disturbances restricted to a specific area of my brain, grew to the complex level on my left temporal lobe. I believe this development was influenced by my use of prescribed medications. Several neurologists (...) from Los Angeles to San Francisco directed various electroencephalograms (EEGs), including a week–long, prescription–free EEG in the hospital; magnetic resonance imaging tests (MRIs); computed tomography (CT) scans anywhere from forty–five minutes to four hours each; and blood profiles to help determine my situation. For legal reasons, one neurologist even had me sign a release stating that he was not able to diagnose my situation.Test results present limited information about my brain and without ever saying, “I don’t know,” these neurologists communicated my test results by utilizing technical terms and thus not always answering my questions. After explaining that my head turns to the left while my right hand shakes, symptoms that have been recognized and reported by several friends and family members, my doctor replied that a seizure on the left side of my brain should cause my head to turn to the right and then changed the subject. I felt like asking, “Am I doing it wrong?”The brain is different from other parts of our anatomy in that it can’t be replaced like a kidney, heart or other organ. It cannot be removed like tonsils, an appendix or even a limb. It can be physically studied or repaired while functioning but the resulting percentage of survival or proper operation of the body after surgery is minimal and the number of people requiring such attention is so low that the amount is scanty. A dead brain limits the analysis of its functions.My “disabilities” involve spontaneous uncontrolled loss of consciousness, exhaustion, mood swings, and the suspension of driving privileges. Activity interference, extra naps, losing friends and not being able to get around are definite disadvantages. However, everyone needs to manage personal problems. No one is perfect.Public transit schedules and directions don’t always offer me the transportation I need. Fortunately, the combination of a bus ride with walking or running can serve my needs while also helping me to keep physically healthy.Limited benefits include discounted transit and the option to ride instead of walking or running. A trip to Nana’s on the train is always a treat.I’d rather not be branded “disabled” even though those who understand my situation address me with compassionate, sympathetic attention, [End Page E4] always asking how I physically feel. I feel fine. A seizure is only a quick, conscious loss of time and an occasional scrape on the knee. I’m more annoyed when I notice strangers looking suspiciously at my public transport discount card as if I don’t really deserve it.Like the “disability” brand, the medications I’ve taken, Dilantin, Neurontin, Depakote, Keppra and Lamictal, among others, all of which produced serious side effects without reducing the frequency of my seizures have only been a cover–up, preventing a search for the true cause and effective treatment of my seizures. Being identified as disabled has only limited my daily schedule. I am not disabled, as society has unfortunately characterized me.My seizures began in 1993, the year our FDA started approving rBGH, recombinant bovine growth hormone, man–made for the use on dairy cows to enhance their milk production. As a result, milk on the market increased while keeping the price from rising, as demonstrated in Economics I. Can the use of rBGH act on my brain in any way?One neurologist, in order to avoid the responsibility of inappropriate recommendations, presented his thoughts in the form of questions, encouraging me to consider options.“You’ve tried all of these medications?”“Has your diet alteration made any difference in your seizures?”“Have you tried organic foods?”His inquiries persuaded me to contemplate whether drugs are an answer to my problem, pay attention to differences in my life and... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Chance to CutBruce H. CampbellMy gloved hand reaches for progressively sharper surgical instruments. The prior radiation therapy and recurrent cancer [End Page E3] have made his neck tissues as stiff and hard as an old block of wood; everything appears too dull and feels too dry under the bright operating room lights. I push, dissect, urge, divide, prod, and spread with little effect.The nursing staff keeps to its (...) routine—completing computer entries, retrieving supplies, counting sponges—only intermittently aware that things are not going well at the point of attack. Nondescript music plays softly and the anesthesia machine continues to emit its gentle sounds. The junior resident—assisting me with the first of many neck dissections she will see during her five years of training—grips the retractor as she has been told and dabs the wound periodically to clear any blood or fluid.I glance up to recheck the CT scan. It confirms that this man’s recurrent cancer is just below the next layer of neck muscles. There are also some large blood vessels and major nerves nearby. I am confident, though, that I will be able to expose the mass, protect all of the critical structures, and safely remove the cancer.Curing cancer with surgery is no small feat, mind you. Cancer is, after all, a molecular disease not easily confined to an obvious lump, even though we sometimes refer to a malignant mass being “like a walnut” or “as hard and round as a marble.” The actual disease rests deep inside each cancer cell where the genetic code—the DNA—makes mistake–after–mistake. If cancer is to be cured with a surgical procedure, the surgeon must remove every last cell that is capable of making the same nonsensical, life–threatening error. Given Science’s rudimentary knowledge of cancer cell dynamics and signaling, it’s a miracle that surgery ever works. Yet, we continue to try. And we succeed just often enough to keep on trying.I rearrange the retractors and alter my approach. My mentors would have known what to do next, I imagine. My training included time well–spent with brilliant and technically–gifted surgeons. How would they have approached this case? Their experience and instincts might have told them to open the wound more widely, work the lateral and deep margins first, or position the instruments differently.Perhaps, one of my mentors would have attacked this man’s tumor using the same approach I am attempting but would have known exactly where to exploit some area of weakness that I cannot locate. A few swift, confident moves and he would have held the mass in his hands. “That’s it. We’re done,” he would have said.I met this patient several months ago when his cancer was first discovered and have seen him throughout his course of treatment. Recently, his daughter had accompanied him to the office to review his options. “Treatment has been rugged, Doc,” he reminded me. “The cancer’s still there and they said I can’t get any more radiation. Chemo would only prolong things. I don’t really want surgery, but what choice do I have if I want to be cured?”“Supportive care is an option, but the only curative approach is surgery.”“Well, I’m not ready to quit yet, Doc. I got grand-kids, y’know. I want to watch them grow up.” He nodded to his daughter. “I’m in charge of spoiling her little boys.”The daughter smiled. We crowded around the computer screen to look at the scans. I showed them how the tumor was invading and destroying surrounding structures. I described the surgery and the risks.“There are many things I will not know about your tumor until we are actually in the operating room,” I explained. Surgery in the setting of recurrent disease involves a series of on–the–spot decisions and course corrections. The odds of success are unknowable. “Sometimes, the only way to find out if we can remove the cancer is simply to try.”He took a deep breath and looked at his daughter. “Well then, Doc, if surgery is the only... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bringing Cancer Care to Those who Don't Have ItLawrence N. ShulmanI have been treating cancer patients in the Harvard Medical School hospitals since 1977, and in those 35 years we have made tremendous progress. Though work still needs to be done, and far too many patients still die of cancer, many are cured. In particular, children and young adults have a high rate of cure from such diseases as (...) Hodgkin's lymphoma, non-Hodgkin's lymphoma, acute lymphoblastic leukemia, and childhood sarcoma. Patients with breast cancer in the US have a greater than 80% chance for long-term survival. The death rate from cervical cancer in the US is very low. These results have been achieved by making diagnoses earlier, in many cases surgical excision, and often systemic therapies such as chemotherapy, hormonal therapy, radiation therapy, and more recently by using so-called "targeted" therapies—those directed at particular molecular characteristics of the cancer cells.Princess Dina Mired has said that the opportunity to survive cancer should not be an accident of geography. In cases where we already have effective and inexpensive tools to cure cancer, these treatments should be considered a basic human right, a life-saving medical service.I met Patty, a young woman living in the U.S. during November of her senior year in high school, after she discovered a small lump above her left collar bone. Though she felt entirely well, she called her primary care doctor who saw her the next day, felt the enlarged lymph node, and referred her to a surgeon, who did a biopsy later that week. Her primary care doctor also called me, and we scheduled a visit when the pathology results were available. The following week the pathologist notified Patty's pediatrician that the biopsy showed Hodgkin's lymphoma. When I met Patty, she was a bright and focused young woman, waiting to hear about her college applications and enjoying her senior year. Her cancer diagnosis was completely out of context with her life as she planned it, but with the support of her family and boyfriend, she seemed prepared to take things one step at a time. A PET CT scan demonstrated a modest mass in the mediastinum (chest), but no other disease. She was in an early stage of the disease with an excellent prognosis. We recommended and administered six months of chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine—four chemotherapy agents that are off-patent, and relatively inexpensive. She lost her hair, not a trivial issue for her, but otherwise felt reasonably well during the treatment. She was determined to graduate with her classmates, and was able continue to attend school and keep up with her work. In June, seven months into her cancer diagnosis and treatment, she graduated with honors, and was on track to enroll in college in September.Like other 18-year-old women with Hodgkin's lymphoma, Patty had an over 80% chance for cure with the potential for a long and productive life ahead of her because we could perform a biopsy, make a diagnosis, and safely and effectively treat her with four inexpensive, off-patent, chemotherapy drugs. She had nearly the same likelihood of living a long and fruitful life as her classmates, and had the same chances for childbearing. In my line of work, with the knowledge we now possess, to allow someone like Patty to die without a chance of curative care is simply unacceptable. Treatment of curable cancers should be considered on par with the right to clean water, adequate nutrition, treatment for infectious disease, and access to maternal and child healthcare services.But in many places in the world, people with cancers we could easily eradicate in Boston have no access to cancer services, and do die unnecessarily. The local healthcare infrastructure has no [End Page E10] capacity to evaluate a patient, perform or process a biopsy, make a diagnosis, or treat the patient with potentially curative surgery, chemotherapy and radiation. I have rounded on the wards of hospitals in developing countries, stopping to talk with numerous patients like Patty: young women, some of whom might have had Hodgkin's lymphoma, but no... (shrink)

Mathematical models of tumour invasion appear as interesting tools for connecting the information extracted from medical imaging techniques and the large amount of data collected at the cellular and molecular levels. Most of the recent studies have used stochastic models of cell translocation for the comparison of computer simulations with histological solid tumour sections in order to discriminate and characterise expansive growth and active cell movements during host tissue invasion. This paper describes how a deterministic approach based on reaction-diffusion models (...) and their generalisation in the mechano-chemical framework developed in the study of biological morphogenesis can be an alternative for analysing tumour morphological patterns. We support these considerations by reviewing two studies. In the first example, successful comparison of simulated brain tumour growth with a time sequence of computerised tomography (CT) scans leads to a quantification of the clinical parameters describing the invasion process and the therapy. The second example considers minimal hypotheses relating cell motility and cell traction forces. Using this model, we can simulate the bifurcation from an homogeneous distribution of cells at the tumour surface toward a nonhomogeneous density pattern which could characterise a pre-invasive stage at the tumour-host tissue interface. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Transformation:Power in Persistence and PerspectiveTyler BendrickWe've got another meth napper," my resident stated. With an introduction like that, it is hard not to be immediately labeled as a "difficult patient." Being the only Spanish-speaking person on the team, I, a third-year medical student, became the primary point of contact for this severely injured patient. He was an only-Spanish-speaking, 36-year-old male admitted [End Page 7] to our trauma service (...) after he was hit by a truck while riding his bicycle. Unbeknownst to me at the time, the 14 days I spent caring for this man would become one of the most pivotal learning experiences of my medical school career. It changed not only how I understand and approach "difficult patients" but expanded my knowledge of the complexities and challenges of the current healthcare system and how we, as physicians and healthcare providers, can deliver the best care to patients with low health literacy and limited resources.So, what is a "meth napper?" I questioned. "Well, meth is a super stimulant," my resident explained. "When people are frequent meth users, they get used to functioning normally with high levels of stimulants in their body, reducing the normal regulation of wakefulness. When the amphetamine is removed (such as upon admission to the hospital), the body is left to fend for itself, and thus patients oftentimes sleep for 23 hours a day for about 3 to 5 days while their body works to detox and normalize hormones."As predicted, my new friend, "Joe," was napping when I first went to see him. Thinking back, the word "napping" does not accurately describe his level of somnolence. He was virtually unarousable, and I took to a sternal rub to wake him up at 5 a.m. after his traumatic exploratory laparotomy the night before. Once aroused, he was furious. "Estoy bien. Tengo dolor y tengo hambre," he grunted at me. (I am fine, and I am in pain and hungry!). "Ok, Joe," I replied in Spanish, "I am just going to do a quick exam and you can go back to sleep. We will give you medications for your pain. You had a big surgery on your intestines, so you cannot eat or drink right now. If everything goes well in the next couple of days and you start walking around, we can advance your diet." He begrudgingly let me examine him, never opening his eyes, and I left and went about my day.We continued this routine for five days. I would periodically check on him and usually found him sleeping. When awake, he refused to work with physical therapists, get up and walk or go to the bathroom, shower, use his spirometer, or converse with the nursing staff. He seemed completely disinterested in recovery. About day three, we slowly advanced his diet to clear liquids so he could quench his thirst. Sometimes his wife was there, and she would ask for updates, to which I could only reply, "We have to wait until he is more awake or willing to work with us." I was getting frustrated, as it seemed that his noncompliance was becoming his barrier to discharge.But on day six, everything changed. I went to check on Joe, and he was wide awake, vomiting, and irate. He shouted that he was in incredible pain, and his incision was wet. He was also complaining that he had not eaten in five days, and was insisting that we were starving him. Again, I calmly explained (as I had multiple times a day for the past five days) that his major abdominal surgery prevented us from feeding him until his intestines healed. We were giving him fluids and nutrition through his IV lines, so he was not starving to death. I rushed to get my resident to examine his oozing wound, and after a CT scan and an x-ray, we discovered what we feared: His wound had opened down to the fascia, "dehiscence," as it is called. On top of this, he now had a bowel obstruction, causing his vomiting. His lack of mobility for the past five days had slowed his... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Over the YearsKimberly RockerMy daughter was diagnosed with an Ependymoma brain tumor in 1986 at the age of 19 months. Our journey began when we realized that we had become concerned about her falling. For example, we were staying at a lodge with a large stone fi replace and both my husband and myself were careful to cover the area with pillows from the couch. Then there were the (...) sporadic “jokes” from strangers who would say, “what has she been drinking?” as she walked past with a slight stagger in her gait. We took her to the pediatrician who listened to my concerns and then watched her walk in a narrow hallway. Surprisingly, she didn’t seem to stagger and she walked very “toddler–like” down the hall. We learned later that this tighter area would help compensate for my daughter’s lack of balance. We were told that she simply needed to develop her gross motor skill more and that she would outgrow it and I was simply an over–concerned first time mom. Unfortunately, the pediatrician failed to recall that my daughter had been walking since she was 11 ½ months old and the current lack of coordination and balance was actually a regression in her motor skills. This negative change in her abilities should have been seen as a red flag.I still couldn’t shake the nagging feeling that something was wrong. Since our doctor had been unresponsive to my concerns, I made an appointment with another doctor. I told my husband that if the new doctor is just as unconcerned about our daughter’s gross motor skills, then I would let it go. The new doctor refrained from making judgments about my parenting skills and concerns. She listened carefully as I described the situation. She examined my daughter and watched her walk in the large hospital hallway. Her next step, one that our regular doctor failed to do, was to measure her head circumference. The measurement exceeded the 100–percentile mark. They were immediately concerned and ordered a CT scan right away. The diagnosis was a brain tumor and due to the size and location, they didn’t expect her to live. We called family and said our beautiful little girl was very sick and was going to die.As a parent, we often know our children well. This can be both a help and a hindrance. Since the changes in our daughters walking skills declined gradually over several months, it was difficult for us to see just how far she had declined. We have a [End Page 25] video of our daughter taken just a few weeks before her diagnosis. I have only watched it a couple of times because it is difficult to see. It is painfully obvious that there is something terribly wrong. It does make me question our parenting and ability to know what is best for our child’s well being. Add to that a doctor that made you feel very inadequate as a parent, it was hard to have the confidence to question the doctor. But, that small quiet voice kept getting louder, demanding to be heard.My daughter will be 29 years old this August. One thing I remember very clearly during that first year is that I just wanted to know that somewhere there was another child who survived to live a happy, healthy life. At that time, it was difficult to find. During those first few months after our diagnosis, we met three other families who had daughters with brain tumors, Nina, Larissa and Wendy. My daughter is the only one still alive. We thank God for the gift of life He gave to our daughter but are full of sorrow for the families that suffered such a difficult loss. There were many miracles and many challenges along the way regarding her recovery. I believe our story can give hope to families as they struggle with this terrible diagnosis.One of our first miracles was the fact that the neurosurgeons were able to remove all visible evidence of the tumor. This is rarely the case since removing the tumor can also damage healthy areas of... (shrink)

With new technologies come new ethical challenges. Often, we can apply previously established principles, even though it may take some time to fully understand the detail of the new technology - or the questions that arise from it. The International Commission on Radiological Protection, for example, was founded in 1928 and has based its advice on balancing the radiation exposure associated with X-rays and CT scans with the diagnostic benefits of the new investigations. They have regularly updated their advice (...) as evidence has accumulated and technologies have changed,1 and have been able to extrapolate from well-established ethical principles. Other new technologies lend themselves less well to off-the-peg ethical solutions. In several articles in this edition the ethical challenges associated with the use of artificial intelligence in medicine are addressed. Although multiple ethical codes and guidelines have been written on the use and development of AI, Hagendorf noted that many of them reiterated a ‘ deontologically oriented, action-restricting ethic based on universal abidance of principles and rules’. 2 Applying pre-existing ethical frameworks to artificial intelligence is problematic for several reasons. In particular, AI has two characteristics which are very different from the current clinical practice on which traditional medical ethics are based: 1. The so called ‘black box’ of deep learning, whereby a deep neural network is trained to iteratively adapt to make …. (shrink)

I felt good about myself, driving to the free medical clinic that evening. A full professor at a medical school, leaving my warm home on a cold night after a day at the hospital, seeing patients in clinic in the morning and teaching second‐year students medical ethics in the afternoon (autonomy was the theme; we'd covered beneficence and maleficence earlier in the week). Once a month, patients with cardiac problems come to the clinic, and this was the night. Two students (...) presented the patient, a middle‐aged woman with chest pain. Their presentation was disjointed, in part because of their inexperience, in part because she spoke no English and her story was obtained with the help of a translator. Her eyes rarely met mine; she kept glancing at the translator. I auscultated her heart and lungs, letting the students listen through my stethoscope. What to do now? Had she been a patient that morning back in my clinic, I would have thought to myself, “I can't get a good history; why not do a stress test?” I thought, for what seemed like an eternity: If I send her for a stress test, that will deplete the funds needed for other patients. How important is this test? Is it really necessary? If I send her for a stress test, will someone with a suspicious mass on their chest x‐ray not be able to get a CT scan because no money is left? (shrink)

In “Body, Cyborgs and the Politics of Incarnation,” Bruno Latour recounts the story of Professor Paul Churchland, his colleague, carrying a portrait of his wife. “Nothing unusual in this,” Latour writes. “No, except that this picture was an image produced by computed tomography, a CT scan of his wife’s inner brain, in full colour”. The image of Professor Church-land proudly showing off a full-color CT of his wife’s beautiful brain has a wonderful sense of absurdity to it, and its punch (...) line depends on the reader being jolted by the strangeness of medical imagery standing in place of portraiture—no matter how stunning the cerebellum.However.. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Sweating the Small StuffTim CunninghamAs an emergency nurse, I often do not notice the small stressors as compared to the loads of intense physical and emotional suffering I witness while working at a level–one–trauma center. The horrendous deaths and injuries caused by gun violence, motorized vehicles, people in emotional distress and those suffering from chronic diseases build up on the mind as a veritable ‘scrapbook of nightmares.’ Emergency providers (...) know, in taking on this profession, that this is ‘all in a day’s work.’ Consequently, we put our selves at risk for emotional burnout as we bear witness to profound suffering while trying to improve lives.I see the traumas, the end–of–life decision making thrust upon families amidst a medical crisis and the other aspects of emergent suffering as bails of hay, against which I tried to build coping mechanisms in order to experience them but also be able to let go. For the most part I am confident to report that I have been able to work through major traumatic situations without belaboring the emotional residue. What I have failed to notice though are not the bails of hay, but individual straws of which they are made.A straw that nearly broke my back came to my pediatric emergency room as a 9–year–old girl who was involved in a low speed motor vehicle collision. She was restrained in the passenger seat; and although she was walking at the scene and crying, she was backboarded by EMS and placed in a cervical spine brace. On arrival to our emergency department she presented with normal vital signs and mutation. Her only complaint was diffuse abdominal pain. We preformed a FAST (Focused Assessment with Sonography for Trauma) exam, which was negative for free abdominal blood. Despite our efforts to make the patient comfortable, we were unable to ease her pain. The patient reported that her pain decreased after we took her off the backboard, but she still did not feel herself.Our attending and resident physicians decided that this child should have an abdominal computed tomography scan (CT) to rule out organ damage with subsequent bleeding. According to hospital protocol, this decision was within our standards of care. I stood by the family when the physician team discussed the plan of care and noticed the parents’ collective body language, which was troubled. I left the room with the physicians but not long after, the family subtly requested that I speak with them.The family was concerned about the radiation to which their child would be exposed. At the same time, they too were concerned about her abdominal pain and understood that a CT could confirm serious abdominal injury. They knew the gravity of the worst–case scenario and wanted to do what was best for their child.The mother asked me if this girl were my child what would I do.My first thought was: No CT, go home, watch her and return if symptoms worsen. My second thought conflicted with the first as I realized this was instruction that fell out of protocol differing from the opinions of the physician team. I paused before responding and found myself sputtering some pointless information about CT scans and mechanisms of injuries sustained from car accidents—I [End Page E9] was filling space, avoiding their question as I pondered the best answer.The girl’s parents told me that one was leaning towards the CT and the other against, they wanted my advice to make a decision. They pressed me saying, “What would you do.” Although I felt an uneasiness and nausea in that moment, I told them my truth, which was that I would go home without the CT.The family appeared relieved and I felt the sensation of stress leaving my body as if I had just taken a deep breath. Contented, but a daughter still with abdominal pain, the family left that evening with specific instructions to watch for adverse symptoms.In that moment, I felt like I had done the right thing but by the end of my shift I left work questioning my choice. I lost sleep that night because of... (shrink)

There has been a significant increase in the use of radiological services in the past 30 years. There are many reasons for this, but one has received little attention: the increased role of patient autonomy in healthcare. Patients demand x rays, CT scans, MRI, and positron emission tomography scans. The key question in this article is how a moral principle, such as respect for patient autonomy, can influence the extension of radiological services. A literature review reveals how patient (...) autonomy is acknowledged in radiology, and how it is used both to explain and to justify the increase in radiological examinations. Furthermore, it also shows how the premises favouring patients’ exercise of their autonomy are not always present, which makes patient autonomy subject to adverse side effects and even abuse. Patient autonomy can be used to reduce the professionals’ responsibility for radiological examinations , to increase the popularity of the profession , to increase the income of the professionals or their institutions, and to promote professional activity. Patient autonomy intended to reduce paternalism, to legitimise otherwise morally unjustifiable actions , and to protect patients, can easily be used as a moral means for opposite ends. These adverse effects are not peculiar to radiology. However, they emerge particularly clearly in explanations and justifications of the substantial increase in radiological services, as well as in debates on overuse of radiological services. (shrink)

Individual health assessments (IHAs) for asymptomatic individuals provide a challenge to traditional distinctions between patient care and non-medical practice. They may involve undue radiation exposure, lead to false positives, and involve high out-of-pocket costs for recipients. A recent paper (Journal of the American College of Radiology 13(12): 1447–1457.e1, 2016) has criticised the use of IHAs and argued that recipients should be classified as ‘presenters’, not ‘patients’, to distinguish it from regular medical care. I critique this classificatory move, on two grounds: (...) one, it is conceptually suspect. Two, it obviates the medical ethics framework for IHAs, potentially exposing recipients of IHAs to lower standards of oversight and protection. Responsible regulation of IHAs will be easier to ethically justify if those seeking IHAs are considered patients and not merely presenters. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Down the Medical Rabbit HoleAnonymous ThreeEditors’ Note: This woman’s child was treated for an astrocytoma at 8–years–old. The surgery included tumor resection and placement of a ventricular peritoneal shunt, which manages the flow, drainage and pressure of cerebral spinal fluid (CSF ) throughout the brain and spinal column.Am I aliveWhat’s this pain I feelAching insideMaking me kneelDown to the groundSubmissiveLike I’ve been sentTo Hell–AnonymousI am making a time capsule (...) of words. If I don’t write these words now, how will I remember? It is for her. She will need these words to know who she is.They took her at the lowest point, when she was barfing and admitting she needed to be in the emergency room (ER). And they stripped her of the ability to use her words to defend herself.“There’s really no reason for you to be here. The x–ray of your shunt tubing looks fine. The CT of your head looks fine. You should think about going home.” I start to speak, but she is speaking so I wait to hear what she will say.“I was worried since my side hurts so bad that maybe it was my appendix and I didn’t want it to burst and then have the infection go up my shunt, I know someone that that happened to, and then my head was exploding and I threw–up.”“That’s when we have to come in to the ER “ I say. “We’ve done this before. We wait until the last possible moment before coming. You’ve seen us here for almost 12 hours now, but we waited more than 24 hours before coming and she was just like this the whole time.”“One of the only things we can see that might be wrong is that we think she might be constipated.”“I try to stay on top of it, ”My 20-year-old says. “I’ve been taking more pain killers lately because my head is always killing me and I push myself to make it to class. But I take stuff to make it easier for me so I don’t get constipated. Last Wednesday during class my head was exploding and I had to vomit. I don’t think my shunt is broken. But...”I interrupt, which is my job, because they are not hearing her, still she gives me hated looks, “She spends two days in bed laying basically flat so she can spend one day or even a few hours vertical the next day. This has been progressing for a while. Last May she had surgery for a CSF leak in her spine. But the headaches are different this time.”“We really think you should consider going home, the tests we’ve done look good.”This is the part that always happens, the part where I say you go into the twilight zone or down Alice’s rabbit hole. In May I had to demand that she have the right to sit up, pain free in the hospital for two hours before leaving. And that is how they admitted her, Mother wants her to sit upright.Here we are again 15 days before Christmas back in the ER—they, meaning the white coats, disbelieving us.She broke then, like a piece of a falling statue, an arm or a leg or part of a shoulder busting off. “I can’t go on like this, my head is exploding and I push myself so hard just to walk across campus [End Page 18] and when I’m sitting in class I know I shouldn’t be there, it’s just so hard. I had a surgery in April last year to replace my shunt and I never really bounced back, and then they found the cyst in my back and the leak and after that surgery I just couldn’t get any energy and my head still hurt.”They don’t know that she never tells anyone any of this.“I know you don’t see anything on her scans,” I say. They always look fine... (shrink)

Today, advances in medicine and biotechnology occur at a rapid pace and have a profound impact on our lives. Mechanical devices can sustain an injured person's life indefinitely. Computed tomography (CT) and magnetic resonance imaging (MRI) scans of the body and brain can reveal disorders before symptoms appear. Genetic testing of embryos can predict whether people will have diseases earlier or later in life. It may even become possible to clone human beings. These and other developments raise difficult ethical (...) questions. Biomedical Ethics is an engaging philosophical introduction to the most important ethical positions and arguments in six areas of biomedicine: the patient-doctor relationship, medical research on humans, reproductive rights and technologies, genetics, medical decisions at the end of life, and the allocation of scarce medical resources. Concisely capturing the historical, contemporary, and future-oriented aspects of the field, author Walter Glannon discusses both perennial issues in medicine, such as doctors' duties to patients, and recent and emerging issues in scientific innovation, including gene therapy and cloning. Ideal for undergraduate courses in contemporary moral problems, introduction to ethics, and introduction to bioethics, Biomedical Ethics is accessible to students who have little or no background in ethical theory, medicine, or biotechnology. (shrink)

The negative impact of adverse experiences in childhood on neurodevelopment is well documented. Less attention however has been given to the impact of variations in “normative” parenting behaviors. The influence of these parenting behaviors is likely to be marked during periods of rapid brain reorganization, such as late childhood. The aim of the current study was to investigate associations between normative parenting behaviors and the development of structural brain networks across late childhood. Data were collected from a longitudinal sample of (...) 114 mother-child dyads (54% female children,Mage 8.41 years, SD = 0.32 years), recruited from low socioeconomic areas of Melbourne, Australia. At the first assessment parenting behaviors were coded from two lab-based interaction tasks and structural magnetic resonance imaging (MRI) scans of the children were performed. At the second assessment, approximately 18 months later (Mage 9.97 years, SD = 0.37 years) MRI scans were repeated. Cortical thickness (CT) was extracted from T1-weighted images using FreeSurfer. Structural covariance (SC) networks were constructed from partial correlations of CT estimates between brain regions and estimates of network efficiency and modularity were obtained for each time point. The change in these network measures, from Time 1 to Time 2, was also calculated. At Time 2, less positive maternal affective behavior was associated with higher modularity (more segregated networks), while negative maternal affective behavior was not related. No support was found for an association between local or global efficacy and maternal affective behaviors at Time 2. Similarly, no support was demonstrated for associations between maternal affective behaviors and change in network efficiency and modularity, from Time 1 to Time 2. These results indicate that normative variations in parenting may influence the development of structural brain networks in late childhood and extend current knowledge about environmental influences on structural connectivity in a developmental context. (shrink)

A volunteer effort by Artificial Intelligence researchers has shown it can deliver significant research outcomes rapidly to help tackle COVID-19. Within two months, CLAIRE’s self-organising volunteers delivered the World’s first comprehensive curated repository of COVID-19-related datasets useful for drug-repurposing, drafted review papers on the role CT/x-ray scan analysis and robotics could play, and progressed research in other areas. Given the pace required and nature of voluntary efforts, the teams faced a number of challenges. These offer insights in how better to (...) prepare for future volunteer scientific efforts and large scale, data-dependent AI collaborations in general. We offer seven recommendations on how to best leverage such efforts and collaborations in the context of managing future crises. (shrink)

When the character Socrates introduces his allegory of the cave at the beginning of book seven of Plato's Republic, he says that it is a story about “our nature in its education and want of education.”1 If we lack education, we grasp the passing shadows as real; if we are dragged out of the cave by force “along the rough, steep, upward way” toward the sun—that is, if we are educated—we come to recognize things as they are, and therefore the (...) error of our previous perceptions. Many readers of this allegory—from early Christian Neoplatonists to influential twentieth-century interpreters of…. (shrink)

Background: SNOMED CT is a large terminology system designed to represent all aspects of healthcare. Its current form and content result from decades of bottom-up evolution. Due to SNOMED CT’s formal descriptions, it can be considered an ontology. The Basic Formal Ontology (BFO) is a foundational ontology that proposes a small set of disjoint, hierarchically ordered classes, supported by relations and axioms. In contrast, as a typical top-down endeavor, BFO was designed as a foundational framework for domain ontologies in the (...) natural sciences and related disciplines. Whereas it is mostly assumed that domain ontologies should be created as extensions of foundational ontologies, a post-hoc harmonization of consolidated domain ontologies in use, such as SNOMED CT, is known to be challenging. Methods: We explored the feasibility of harmonizing SNOMED CT with BFO, with a focus on the SNOMED CT Clinical Finding hierarchy. With more than 100,000 classes, it accounts for about one third of SNOMED CT’s content. In particular, we represented typical SNOMED CT finding/disorder concepts using description logics under BFO. Three representational patterns were created and the logical entailments analyzed. Results: Under a first scrutiny, the clinical intuition that diseases, disorders, signs and symptoms form a homogeneous ontological upper-level class appeared incompatible with BFO’s upper-level distinction into continuants and occurrents. The Clinical finding class seemed to be an umbrella for all kinds of entities of clinical interest, such as material entities, processes, states, dispositions, and qualities. This suggests the conclusion that Clinical finding would not be a suitable upper-level class from an BFO perspective. On closer inspection of the taxonomic links within this hierarchy and the implicit meaning derived thereof, it became clear that Clinical finding classes do not characterize the entity (e.g. a fracture, allergy, tumor, pain, hemorrhage, seizure, fever) in a literal sense but rather the condition of a patient having that fracture, allergy, pain etc. This gives sense to the current characteristic of the Clinical Finding hierarchy, in which complex classes are modeled as subclasses of their constituents. Most of these taxonomic links are inferred, as the consequence of the ‘role group’ design pattern, which is ubiquitous in SNOMED CT and has often been subject of controversy regarding its semantics. Conclusion: Our analyses resulted in the proposal of (i) equating SNOMED CT’s ‘role group’ property with the reflexive and transitive BFO relation ‘has occurrent part’; and (ii) reinterpreting Clinical Findings as Clinical Occurrents, i.e. temporally extended entities in an organism, having one or more occurrents as temporal parts that occur in continuants. This re-interpretation was corroborated by a manual analysis of classes under Clinical Finding, as well as the identification of similar modeling patterns in other ontologies. As a result, SNOMED CT does not require any content redesign to establish compatibility with BFO, apart from this re-interpretation, and a suggested re-labeling. Regarding the feasibility of harmonizing terminologies with principled foundational ontologies post-hoc, our results provide support to the assumption that this does not necessarily require major redesign efforts, but rather a careful analysis of the implicit assumptions of terminology curators and users. (shrink)

Most everyday tasks involve multiple modalities, which raises the question of how the processing of these modalities is coordinated by the cognitive system. In this paper, we focus on the coordination of visual attention and linguistic processing during speaking. Previous research has shown that objects in a visual scene are fixated before they are mentioned, leading us to hypothesize that the scan pattern of a participant can be used to predict what he or she will say. We test this hypothesis (...) using a data set of cued scene descriptions of photo-realistic scenes. We demonstrate that similar scan patterns are correlated with similar sentences, within and between visual scenes; and that this correlation holds for three phases of the language production process (target identification, sentence planning, and speaking). We also present a simple algorithm that uses scan patterns to accurately predict associated sentences by utilizing similarity-based retrieval. (shrink)

Background: Systematized Nomenclature of Medicine—Clinical Terms (SNOMED CT, hereafter abbreviated SCT) is acomprehensive medical terminology used for standardizing the storage, retrieval, and exchange of electronic healthdata. Some efforts have been made to capture the contents of SCT as Web Ontology Language (OWL), but theseefforts have been hampered by the size and complexity of SCT. Method: Our proposal here is to develop an upper-level ontology and to use it as the basis for defining the termsin SCT in a way that will (...) support quality assurance of SCT, for example, by allowing consistency checks ofdefinitions and the identification and elimination of redundancies in the SCT vocabulary. Our proposed upper-levelSCT ontology (SCTO) is based on the Ontology for General Medical Science (OGMS). Results: The SCTO is implemented in OWL 2, to support automatic inference and consistency checking. Theapproach will allow integration of SCT data with data annotated using Open Biomedical Ontologies (OBO) Foundryontologies, since the use of OGMS will ensure consistency with the Basic Formal Ontology, which is the top-levelontology of the OBO Foundry. Currently, the SCTO contains 304 classes, 28 properties, 2400 axioms, and 1555annotations. It is publicly available through the bioportal athttp://bioportal.bioontology.org/ontologies/SCTO/. Conclusion: The resulting ontology can enhance the semantics of clinical decision support systems and semanticinteroperability among distributed electronic health records. In addition, the populated ontology can be used forthe automation of mobile health applications. (shrink)

Molecular interactions are at the origin of life. How molecules get at different locations in the cell and how they locate their partners is a major and partially unresolved question in biology that is paramount to signaling. Spatio‐temporal correlations of fluctuating fluorescently tagged molecules reveal how they move, interact, and bind in the different cellular compartments. Methods based on fluctuations represent a remarkable technical advancement in biological imaging. Here we discuss image analysis methods based on spatial and temporal correlation of (...) fluctuations, raster image correlation spectroscopy, number and brightness, and spatial cross‐correlations that give us information about how individual molecules move in cells and interact with partners at the single molecule level. These methods can be implemented with a standard laser scanning microscope and produce a cellular level spatio‐temporal map of molecular interactions. (shrink)