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OBJECT - This study was undertaken to assess the reliability of observations of postoperative photographs in assigning House-Brackmann scores as outcome measures for patients following resection of vestibular schwannomas.
METHODS - Forty pictures of differing facial expressions typically elicited from patients for assigning House-Brackmann scores were individually evaluated by neurosurgery residents and faculty members at the University of Alabama at Birmingham; a score was assigned to each picture by the individual raters. The interrater reliability was measured using the Spearman correlation coefficient, Kendall coefficient of concordance, and kappa statistic; internal consistency was calculated using the Cronbach alpha reliability estimate.
RESULTS - The Spearman correlation coefficients showed strong positive association among raters, with a range of values of 0.66 to 0.90. Internal consistency measured by the Cronbach alpha coefficient was excellent (α = 0.97). The Kendall coefficient of concordance for the ordinal grades suggested a substantial degree of agreement among the raters (w = 0.76, p < 0.001).
CONCLUSIONS - Static postoperative photographs are a reliable outcome measure for determining facial nerve function after vestibular schwannoma resection and may serve as a surrogate for the dynamic patient interview.
The Thatcher Illusion or Thatcher Effect (TE--Thompson 1980, Perception 9 483-484) reflects the difficulty in perceiving the local inversion of parts when the whole object, generally a face, is globally inverted. We tested the generality of the TE with a range of faces and nonface objects, and observed the TE with many non-face categories including cars, buildings, bikes, and letter strings. In terms of magnitude, the face TE is not exceptionally large compared to other object categories, and the magnitude of the TE can be predicted by performance on this task for upright stimuli, regardless of whether the object is a face or not. We did not observe evidence for a unique mechanism contributing to the TE for faces. We discuss factors that influence the magnitude of the TE, some common across domains and others more specific to a particular category.
OBJECTIVES - Low physician density, undercapacitated laboratory infrastructures, and limited resources are major limitations to the development and implementation of widely accessible cervical cancer prevention programs in sub-Saharan Africa.
MATERIALS AND METHODS - We developed a system operated by nonphysician health providers that used widely available and affordable communication technology to create locally adaptable and sustainable public sector cervical cancer prevention program in Zambia, one of the world's poorest countries.
RESULTS - Nurses were trained to perform visual inspection with acetic acid aided by digital cervicography using predefined criteria. Electronic digital images (cervigrams) were reviewed with patients, and distance consultation was sought as necessary. Same-visit cryotherapy or referral for further evaluation by a gynecologist was offered. The Zambian system of "electronic cervical cancer control" bypasses many of the historic barriers to the delivery of preventive health care to women in low-resource environments while facilitating monitoring, evaluation, and continued education of primary health care providers, patient education, and medical records documentation.
CONCLUSIONS - The electronic cervical cancer control system uses appropriate technology to bridge the gap between screening and diagnosis, thereby facilitating the conduct of "screen-and-treat" programs. The inherent flexibility of the system lends itself to the integration with future infrastructures using rapid molecular human papillomavirus-based screening approaches and wireless telemedicine communications.
Little is known about the intersections of immigration, masculinity and sexual risk behaviours among recently arrived Latino men in the USA. Nine immigrant Latino men from three urban housing communities in the South-eastern USA used photovoice to identify and explore their lived experiences. From the participants' photographs and words, thirteen themes emerged within four domains. The immigration experience and sociocultural norms and expectations of masculinity were factors identified decreasing Latino men's sense of power and increasing stress, which lead to sexual risk. Latino community strengths and general community strengths were factors that participants identified as promoting health and preventing risk. These themes influenced the development of a conceptual model to explain risk among immigrant Latino men. This model requires further exploration and may prove useful in intervention development.
PURPOSE - To describe a novel computer-based image analysis method that is being developed to assist and automate the diagnosis of retinal disease.
METHODS - Content-based image retrieval is the process of retrieving related images from large database collections using their pictorial content. The content feature list becomes the index for storage, search, and retrieval of related images from a library based upon specific visual characteristics. Low-level analyses use feature description models and higher-level analyses use perceptual organization and spatial relationships, including clinical metadata, to extract semantic information.
RESULTS - We defined, extracted, and tested a large number of region- and lesion-based features from a dataset of 395 retinal images. Using a statistical hold-one-out method, independent queries for each image were submitted to the system and a diagnostic prediction was formulated. The diagnostic sensitivity for all stratified levels of age-related macular degeneration ranged from 75% to 100%. Similarly, the sensitivity of detection and accuracy for proliferative diabetic retinopathy ranged from 75% to 91.7% and for nonproliferative diabetic retinopathy, ranged from 75% to 94.7%. The overall purity of the diagnosis (specificity) for all disease states in the dataset was 91.3%.
CONCLUSIONS - The probabilistic nature of content-based image retrieval permits us to make statistically relevant predictions regarding the presence, severity, and manifestations of common retinal diseases from digital images in an automated and deterministic manner.
The widespread availability of electronic imaging devices throughout the medical community is leading to a growing body of research on image processing and analysis to diagnose retinal disease such as diabetic retinopathy (DR). Productive computer-based screening of large, at-risk populations at low cost requires robust, automated image analysis. In this paper we present results for the automatic detection of the optic nerve and localization of the macula using digital red-free fundus photography. Our method relies on the accurate segmentation of the vasculature of the retina followed by the determination of spatial features describing the density, average thickness, and average orientation of the vasculature in relation to the position of the optic nerve. Localization of the macula follows using knowledge of the optic nerve location to detect the horizontal raphe of the retina using a geometric model of the vasculature. We report 90.4% detection performance for the optic nerve and 92.5% localization performance for the macula for red-free fundus images representing a population of 345 images corresponding to 269 patients with 18 different pathologies associated with DR and other common retinal diseases such as age-related macular degeneration.
PURPOSE - To compare cytology with cervicography in HIV-infected and uninfected adolescent females.
METHODS - At the time of analysis, 334 girls aged 13-19 years from 13 U.S. cities were participating in a prospective study of HIV infection. All subjects had cytology and a Cervigram (cervicography) performed at two consecutive visits 6 months apart, referred to as visit (V) 1 and 2. Cervigrams were sent to the parent company for diagnosis and were categorized as: "negative" or "positive" (compatible with low-grade or high-grade squamous intraepithelial lesions [SIL]). Cytology was considered abnormal if the subject had SIL at either V1 or V2. Sensitivity, specificity, and positive predictive value (PPV) of the Cervigram were calculated compared with repeat Papanicolaou (Pap) smears.
RESULTS - Two consecutive adequate Pap smears were available for analysis in 200 adolescents; 51% (95% CI, 43-59) of the 142 HIV-positive youth and 19% (95% CI, 9-29) of the 58 HIV-negative youth had SIL on at least one Pap smear (p < .001). A positive Cervigram was observed in 44% (95% CI, 36-53) of the HIV-infected group and 29% (95% CI, 17-41) of the HIV-uninfected group (p =.06). For the HIV-infected group, the sensitivity, specificity, and PPV of the Cervigram to detect SIL were 58% (95% CI, 45-71), 69% (95%CI, 57-80), and 64% (95%CI, 52-77), respectively. For the HIV-uninfected group, the sensitivity, specificity, and PPV were 64% (95% CI, 31-89), 80% (95% CI, 65-90), and 44% (95% CI, 19-68), respectively. The combined sensitivity, using both the Pap smear and Cervigram result from V1 to detect SIL, was 82% (95% CI, 71-91 for HIV+ and 48-98 for HIV-) in both groups. However, the PPV based the performance of the Cervigram in Pap smear-negative women as 33% (95% CI, 17-53) and 15% (95% CI, 2-45) for the HIV-infected and uninfected group, respectively (p = not significant [ns]).
CONCLUSIONS - Although the sensitivity of a single Pap smear increased significantly when the Cervigram was used as an adjunct, the low PPV in both HIV-infected and uninfected groups, suggests that cervicography has a limited utility for precancer and cervical cancer screening in high-risk adolescent populations.
Copyright Society for Adolescent Medicine, 2003
The objective of this study was to examine factors, including human immunodeficiency virus (HIV) infection, associated with ectopy among adolescent girls aged 12-20 years who were participating in an ongoing study of HIV infection in adolescents. Samples for detection of bacterial vaginosis, Chlamydia trachomatis, and Neisseria gonorrhoeae and a high-resolution photograph of the cervix for ectopy measurement were collected. Ectopy data for 189 and 92 HIV-positive and -negative adolescents, respectively, were examined. Although univariate analysis found HIV infection and oral contraceptive use to be associated with the amount of ectopy, multivariate logistic regression analysis showed that only number of lifetime sex partners was a significant predictor, with more partners associated with less ectopy (odds ratio, 0.47; 95% confidence interval, 0.22-1.00; P=.05). In summary, adolescent girls with greater numbers of lifetime sex partners were more likely to have mature cervixes (less ectopy). HIV infection was not independently associated with ectopy.
A strategy to update preoperative imaging for image-guided surgery using readily available intraoperative information has been developed and implemented. A patient-specific three-dimensional finite element model of the brain is generated from preoperative MRI and used to simulate deformation resulting from multiple surgical processes. Intraoperatively obtained sparse imaging data, such as from digital cameras or ultrasonography, is then used to prescribe the displacement of selected points within the model. Interpolation to the resolution of preoperative imaging may then be performed based upon the model. The algorithms for generation of the finite element model and for its subsequent deformation have been successfully validated using a pig brain model, and preliminary clinical application in the operating room has demonstrated feasibility.
Copyright 2000 S. Karger AG, Basel
Previous investigators examined how architectural features of residences for adults with mental retardation contributed to the visual appearance of homelikeness. Acoustical characteristics of 18 residences for people with mental retardation were examined here. As part of a concurrent study, college undergraduates rated photographs of rooms in each house for their apparent homelikeness. Reverberation times in living and dining rooms were negatively correlated with mean homelikeness ratings. The less homelike rooms had reverberation times that may interfere with speech perception for some people and that were comparable with those found in larger public rooms (e.g., lecture halls). The larger reverberation times in these rooms were the result of insufficient sound absorption by these rooms' furnishings.