Automated informatics may increase the detection rate of suspicious cases of human trafficking-a preliminary study.

Objectives: Worldwide, there is an estimated 40.3 million victims trapped in modern day slavery, including 24.9 million in forced labor and 15.4 million in forced marriage. A majority of labor and sex trafficking survivors report at least one healthcare encounter during their victimization. An approach to an informatics technology solution for identifying trafficked persons in real time, in the hospital / emergency department settings is the primary focus of this paper. Materials and methods: Octavia, a software application implemented in 3 California hospitals, scanned all patient encounters for social and clinical determinants that are consistent predictors of HT. Any encounter that matched these criteria was forwarded to a specially trained High-Risk Navigator who screened the data and when able, made direct contact in an effort to build rapport and possibly provide victim assistance. Results: During the observation period, the automated scanning of hospital patient encounters resulted in a notable increase in the detection of persons who had a likelihood of being trafficked when compared to a pre-project baseline. Discussion: Our experience demonstrated that automated technology is useful to assist healthcare providers in identification of potentially trafficked persons, improving the likelihood of care provision.

Carbohydrate Estimation by a Mobile Phone-Based System Versus Self-Estimations of Individuals With Type 1 Diabetes Mellitus: A Comparative Study.

BACKGROUND: Diabetes mellitus is spreading throughout the world and diabetic individuals have been shown to often assess their food intake inaccurately; therefore, it is a matter of urgency to develop automated diet assessment tools. The recent availability of mobile phones with enhanced capabilities, together with the advances in computer vision, have permitted the development of image analysis apps for the automated assessment of meals. GoCARB is a mobile phone-based system designed to support individuals with type 1 diabetes during daily carbohydrate estimation. In a typical scenario, the user places a reference card next to the dish and acquires two images using a mobile phone. A series of computer vision modules detect the plate and automatically segment and recognize the different food items, while their 3D shape is reconstructed. Finally, the carbohydrate content is calculated by combining the volume of each food item with the nutritional information provided by the USDA Nutrient Database for Standard Reference. OBJECTIVE: The main objective of this study is to assess the accuracy of the GoCARB prototype when used by individuals with type 1 diabetes and to compare it to their own performance in carbohydrate counting. In addition, the user experience and usability of the system is evaluated by questionnaires. METHODS: The study was conducted at the Bern University Hospital, "Inselspital" (Bern, Switzerland) and involved 19 adult volunteers with type 1 diabetes, each participating once. Each study day, a total of six meals of broad diversity were taken from the hospital's restaurant and presented to the participants. The food items were weighed on a standard balance and the true amount of carbohydrate was calculated from the USDA nutrient database. Participants were asked to count the carbohydrate content of each meal independently and then by using GoCARB. At the end of each session, a questionnaire was completed to assess the user's experience with GoCARB. RESULTS: The mean absolute error was 27.89 (SD 38.20) grams of carbohydrate for the estimation of participants, whereas the corresponding value for the GoCARB system was 12.28 (SD 9.56) grams of carbohydrate, which was a significantly better performance ( P=.001). In 75.4% (86/114) of the meals, the GoCARB automatic segmentation was successful and 85.1% (291/342) of individual food items were successfully recognized. Most participants found GoCARB easy to use. CONCLUSIONS: This study indicates that the system is able to estimate, on average, the carbohydrate content of meals with higher accuracy than individuals with type 1 diabetes can. The participants thought the app was useful and easy to use. GoCARB seems to be a well-accepted supportive mHealth tool for the assessment of served-on-a-plate meals.

Interactive Visualization for Singular Fibers of Functions f : R³ → R².

Scalar topology in the form of Morse theory has provided computational tools that analyze and visualize data from scientific and engineering tasks. Contracting isocontours to single points encapsulates variations in isocontour connectivity in the Reeb graph. For multivariate data, isocontours generalize to fibers-inverse images of points in the range, and this area is therefore known as fiber topology. However, fiber topology is less fully developed than Morse theory, and current efforts rely on manual visualizations. This paper presents how to accelerate and semi-automate this task through an interface for visualizing fiber singularities of multivariate functions R³ → R². This interface exploits existing conventions of fiber topology, but also introduces a 3D view based on the extension of Reeb graphs to Reeb spaces. Using the Joint Contour Net, a quantized approximation of the Reeb space, this accelerates topological visualization and permits online perturbation to reduce or remove degeneracies in functions under study. Validation of the interface is performed by assessing whether the interface supports the mathematical workflow both of experts and of less experienced mathematicians.

Computer vision-based carbohydrate estimation for type 1 patients with diabetes using smartphones.

BACKGROUND: Individuals with type 1 diabetes (T1D) have to count the carbohydrates (CHOs) of their meal to estimate the prandial insulin dose needed to compensate for the meal's effect on blood glucose levels. CHO counting is very challenging but also crucial, since an error of 20 grams can substantially impair postprandial control. METHOD: The GoCARB system is a smartphone application designed to support T1D patients with CHO counting of nonpacked foods. In a typical scenario, the user places a reference card next to the dish and acquires 2 images with his/her smartphone. From these images, the plate is detected and the different food items on the plate are automatically segmented and recognized, while their 3D shape is reconstructed. Finally, the food volumes are calculated and the CHO content is estimated by combining the previous results and using the USDA nutritional database. RESULTS: To evaluate the proposed system, a set of 24 multi-food dishes was used. For each dish, 3 pairs of images were taken and for each pair, the system was applied 4 times. The mean absolute percentage error in CHO estimation was 10 ± 12%, which led to a mean absolute error of 6 ± 8 CHO grams for normal-sized dishes. CONCLUSION: The laboratory experiments demonstrated the feasibility of the GoCARB prototype system since the error was below the initial goal of 20 grams. However, further improvements and evaluation are needed prior launching a system able to meet the inter- and intracultural eating habits.

Joint Contour Nets.

Contour Trees and Reeb Graphs are firmly embedded in scientific visualization for analysing univariate (scalar) fields. We generalize this analysis to multivariate fields with a data structure called the Joint Contour Net that quantizes the variation of multiple variables simultaneously. We report the first algorithm for constructing the Joint Contour Net, and demonstrate some of the properties that make it practically useful for visualisation, including accelerating computation by exploiting a relationship with rasterisation in the range of the function.

The experience of patients undergoing awake craniotomy for intracranial masses: expectations, recall, satisfaction and functional outcome.

Introduction. Awake craniotomy is a well-established neurosurgical technique for lesions involving eloquent cortex, however, there is little information regarding patients' subjective experience with this type of surgery. Here we explore the expectations, recall, satisfaction and functional outcome of patients undergoing awake craniotomy. Methods. Three semi-structured interviews using closed- and open-ended questions were conducted with each of 26 consecutive patients (17 males, 9 females; aged 16-78 years) who underwent their first awake craniotomy between 2007 and 2009. Seven patients were interviewed retrospectively, 19 prospectively. Clinical data are included. Results. The following themes emerged from this study: (1) most patients demonstrated a good understanding of the rationale behind awake craniotomy; (2) patients felt the asleep-awake-asleep anaesthetic protocol used in this series was appropriate; (3) patients' confidence and preparedness for surgery was high, attributed to preparation by the surgical team. Seven of 26 (27%) patients had no recollection of being awake. Most patients had a positive anaesthetic and surgical experience, while a minority of patients reported experiencing more than slight pain (2/26; 8%) and discomfort (3/26; 12%), fear (4/26; 15%) or claustrophobia (1/26; 4%) intra-operatively. At follow-up (6 weeks post-operatively), most patients were functionally unimpaired; there was only one permanent neurological complication of surgery. We found that 24/26 (92%) patients were satisfied with their experience; one patient had no opinion and another one was unsatisfied. Five of 26 (19%) patients still reported more than slight discomfort, and 3/26 (12%) reported more than slight pain attributable to the surgery. A summary of the English peer-reviewed literature on the patient experience of awake craniotomy is also incorporated. Conclusions. This study confirms that awake craniotomy using the 'asleep-awake-asleep' anaesthetic protocol is a generally safe and well-tolerated procedure associated overall with satisfactory patients' experiences and neurological outcomes.

Intuitiveness, quality and utility of intraoperative fluorescence videoangiography: Australian Neurosurgical Experience.

INTRODUCTION: The authors have undertaken a study of their intraoperative experience with indocyanine green fluorescence videoangiography (ICGFV). In particular, the intuitiveness, image quality and clinical utility of this technology have been assessed. METHODS: The records of forty-six consecutive craniotomies utilising ICGFV have been retrospectively reviewed: There were 27 aneurysms, 2 extracranial-intracranial (EC-IC) bypasses, 5 arteriovenous malformations (AVM), 1 dural arteriovenous fistula (DAVF), 3 cavernomas, 5 meningiomas, and 3 gliomas. ICGFV was used in 5 awake-craniotomy patients. ICGFV was performed using a Leica OH4 surgical microscope with integrated near-infrared camera and ICG-PULSION. RESULTS: All attempts of intraoperative ICGFV were intuitive. Image quality and resolution were excellent. Arterial and venous phases were comparable to digital subtraction angiography (DSA) but field of view was relatively limited. In 12 operations (26%) the surgeon was substantially benefited from ICGFV findings. In 22 operations (48%), ICGFV was useful but did not influence surgical management. ICGFV was of no benefit in 11 operations (24%) and was misleading in 1 (2%). In this series, ICGFV was of benefit to 1 of 11 (9%) patients with an intracranial neoplasm or cavernoma. CONCLUSIONS: ICGFV is safe, intuitive and provides neurosurgeons with high quality, valuable, real-time imaging of cerebrovascular anatomy. It can assist in intraoperative surgical management and/or stroke prevention particularly during aneurysm clipping, EC-IC bypass and AVM/DAVF surgery.

Minimally invasive surgical ablation of atrial fibrillation: six-month results.

BACKGROUND: A minimally invasive surgery for treatment of atrial fibrillation was developed with bilateral pulmonary vein isolation, mapping, and ablation of the ganglionic plexi and excision of the left atrial appendage. A prospective multicenter registry was created to evaluate the outcomes. METHODS: The procedure was performed through bilateral minithoracotomies with video assistance. It included bilateral pulmonary vein isolation with bipolar radiofrequency with documentation of conduction block, location of ganglionic plexi by high-frequency stimulation, and appropriate ablation and left atrial appendage exclusion/excision. Clinical follow-up at 6 months included monitoring with electrocardiogram, Holter, event monitor, or pacemaker interrogation. RESULTS: One hundred fourteen patients with 60 (52.6%) paroxysmal, 32 (28.1%) persistent, and 22 (19.3%) long-standing persistent atrial fibrillations were treated. The mean age was 59.5 +/- 10.6 years, and 69.3% were men. The mean follow-up period was 204 +/- 41 days (median 195). There were 2 (1.8%) operative mortalities. At 6-month follow-up, with long-term monitoring, 52/60 (86.7%) patients with paroxysmal fibrillations were in normal sinus rhythm and 43/60 (71.7%) were both in normal sinus rhythm and off antiarrhythmic drugs. The patients with persistent atrial fibrillation had a lower success rate, with 18/32 (56.3%) being in normal sinus rhythm and 46.9% both in normal sinus rhythm and off antiarrhythmic drugs; for long-standing persistent cases, 11/22 (50%) were in normal sinus rhythm and 7/22 (31.9%) were also off antiarrhythmic drugs. CONCLUSIONS: Minimally invasive atrial fibrillation surgery is an effective treatment of paroxysmal atrial fibrillation at 6 months. Continuous event monitoring is necessary to accurately assess treatment results. A more extensive lesion set seems to be required for treatment of persistent atrial fibrillation.

Preliminary results of a limited thoracotomy: new approach to treat atrial fibrillation.

OBJECTIVE: To determine efficacy of a new procedure combining epicardial bipolar radiofrequency (RF) pulmonary vein (PV) antrum isolation and ganglionated plexus (GP) ablation for treatment of atrial fibrillation (AF). BACKGROUND: PV antrum electrical isolation and GP ablation have each been associated with elimination of AF. Both of these can be performed epicardially in a single combined surgical procedure, which may have advantages over endocardial ablation. METHODS AND RESULTS: Twenty-one subjects entered a prospective evaluation of limited thoracotomy epicardial bipolar PV antrum isolation, verified by PV recordings, with GP ablation, guided by GP mapping. Procedural success was defined as freedom from AF and antiarrhythmic agents during 1 year of follow-up, including evaluation by prolonged continuous monitoring capable of detecting asymptomatic arrhythmias. All subjects had recordable PV potentials and GP activity prior to ablation. Circumferential epicardial bipolar RF eliminated PV potentials in 18 of 20 right and 14 of 20 left PV antra. This concurrently eliminated 79% of GP activity (125 of 159 active sites); nearly all remaining GP activity could then be eliminated using epicardial bipolar RF forceps. Fifteen of 20 (75%) subjects overall, and 14 of 16 (87.5%) subjects with paroxysmal or persistent AF had a successful procedure. CONCLUSION: Limited thoracotomy epicardial bipolar RF antrum isolation, verified by PV recordings, with GP ablation, guided by GP mapping, is effective treatment for AF and should be considered in patients with paroxysmal or persistent AF.

Fine-grained visualization pipelines and lazy functional languages.

The pipeline model in visualization has evolved from a conceptual model of data processing into a widely used architecture for implementing visualization systems. In the process, a number of capabilities have been introduced, including streaming of data in chunks, distributed pipelines, and demand-driven processing. Visualization systems have invariably built on stateful programming technologies, and these capabilities have had to be implemented explicitly within the lower layers of a complex hierarchy of services. The good news for developers is that applications built on top of this hierarchy can access these capabilities without concern for how they are implemented. The bad news is that by freezing capabilities into low-level services expressive power and flexibility is lost. In this paper we express visualization systems in a programming language that more naturally supports this kind of processing model. Lazy functional languages support fine-grained demand-driven processing, a natural form of streaming, and pipeline-like function composition for assembling applications. The technology thus appears well suited to visualization applications. Using surface extraction algorithms as illustrative examples, and the lazy functional language Haskell, we argue the benefits of clear and concise expression combined with fine-grained, demand-driven computation. Just as visualization provides insight into data, functional abstraction provides new insight into visualization.

Percutaneous placement of a low-profile stent-graft device for aortic dissections.

PURPOSE: The use of stent-grafts has proved to be safe and effective treatment for complicated aortic dissections but usually requires surgical cutdown to accommodate large-profile devices. Preliminary results of the use of a low-profile design that allows percutaneous access are presented. MATERIALS AND METHODS: Fifteen patients with aortic dissection were treated with use of a low-profile stent-graft. Dissection types included Stanford type A (n = 6) and type B (n = 9). The procedures were performed with use of Perclose devices to achieve hemostasis. The stent-graft device was composed of Gianturco stents connected with longitudinal wire struts covered with radially expanded polytetrafluoroethylene. The delivery sheath sizes were 14-20 F. RESULTS: In 87% of patients (13 of 15), the entry tear was excluded completely. Successful femoral closures were achieved in 93% of patients (14 of 15) with use of the suture-mediated devices. In 7% of patients (one of 15), surgical closure of the femoral arteries was required. The rate of pseudoaneurysm occurrence was 7% (one of 15). Hospitalization ranged from 1 to 30 days with a mean duration of 6.5 days. The 30-day mortality rate was 27% (four of 15). In the remaining 11 patients, entry tear sites were excluded and, on follow-up CT examinations, there was thrombosis and retraction of the false lumen and enlargement of the true lumen. CONCLUSION: Preliminary results of the use of a low-profile stent-graft device to treat aortic dissections show that, in most patients, it can be used with a suture-mediated device without surgical exposure of the common femoral artery.