Search results for: coma states and prognosis
2918 The Contribution of the Lomé Charter to Combating Trafficking in Persons at Sea: Nigerian and South African Legal Perspective
Authors: Obinna Emmanuel Nkomadu
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A major maritime problem in the African continent is the widespread proliferation of threats to maritime security, and one of which is the traffic in persons (TIP) at sea, which victims are sometimes assaulted, injured, killed, and in many cases go missing. The South African and Nigerian law on TIP at sea is the Prevention and Combating of Trafficking in Persons Act and the Trafficking in Persons (Prohibition) Enforcement and Administration Act, respectively. These legislation prohibits TIP at sea but does not provides effective and efficient national coordination structures and international cooperation measures against traffickers who engage on human trafficking on the African maritime domain. As a result of the limitations on the maritime security laws of most African States and the maritime security threats on the continent, the African Union in 2016 adopted the African Charter on Maritime Security and Safety and Development in Africa (Lome Charter). The Lomé Charter provides mechanisms for national and international cooperation on maritime security threats, including TIP at sea. However, the Charter is yet to come into force due to the number of States required to accede or ratify the Charter. This paper identifies gaps on existing instruments on TIP at sea by those States and justify on South Africa and Nigeria should adopt the Charter. The justification flow from analysing relevant international law instruments, as well as legislation on human trafficking.Keywords: cooperation against trafficking in persons at sea, lomé charter, maritime security, Nigerian legislation on trafficking in persons, South African legislation on trafficking in person, and trafficking in persons at sea
Procedia PDF Downloads 1512917 Computer-Aided Diagnosis System Based on Multiple Quantitative Magnetic Resonance Imaging Features in the Classification of Brain Tumor
Authors: Chih Jou Hsiao, Chung Ming Lo, Li Chun Hsieh
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Brain tumor is not the cancer having high incidence rate, but its high mortality rate and poor prognosis still make it as a big concern. On clinical examination, the grading of brain tumors depends on pathological features. However, there are some weak points of histopathological analysis which can cause misgrading. For example, the interpretations can be various without a well-known definition. Furthermore, the heterogeneity of malignant tumors is a challenge to extract meaningful tissues under surgical biopsy. With the development of magnetic resonance imaging (MRI), tumor grading can be accomplished by a noninvasive procedure. To improve the diagnostic accuracy further, this study proposed a computer-aided diagnosis (CAD) system based on MRI features to provide suggestions of tumor grading. Gliomas are the most common type of malignant brain tumors (about 70%). This study collected 34 glioblastomas (GBMs) and 73 lower-grade gliomas (LGGs) from The Cancer Imaging Archive. After defining the region-of-interests in MRI images, multiple quantitative morphological features such as region perimeter, region area, compactness, the mean and standard deviation of the normalized radial length, and moment features were extracted from the tumors for classification. As results, two of five morphological features and three of four image moment features achieved p values of <0.001, and the remaining moment feature had p value <0.05. Performance of the CAD system using the combination of all features achieved the accuracy of 83.18% in classifying the gliomas into LGG and GBM. The sensitivity is 70.59% and the specificity is 89.04%. The proposed system can become a second viewer on clinical examinations for radiologists.Keywords: brain tumor, computer-aided diagnosis, gliomas, magnetic resonance imaging
Procedia PDF Downloads 2602916 Primary Melanocytic Tumors of the Central Nervous System: A Clinico-Pathological Study of Seven Cases
Authors: Sushila Jaiswal, Awadhesh Kumar Jaiswal
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Background: Primary melanocytic tumors of the central nervous system (CNS) are uncommon lesions and arise from the melanocytes located within the leptomeninges. Aim and objective: The aim of the study was to evaluate the clinical details, histomorphology of the primary melanocytic tumor of CNS. Method: The study was performed by the retrospective review of the case records of the primary melanocytic tumors of CNS diagnosed in our department. The formalin-fixed, paraffin embedded tissue blocks and tissue sections were retrieved and reviewed. Results: Seven cases (6 males, 1 female; age range- 16-40 years; mean age- 27 years) of primary melanocytic tumors of CNS were retrieved over last seven years. The tumor was intracranial (n=5; frontal – 1 case, parietal – 1 case, cerebello-pontine angle- 1 case, occipital -1 case, foramen magnum-1 case) and intra spinal (n=2; cervical – 2 cases). All patients presented with the neurological deficits related to the location of the tumor. Four cases were malignant melanoma; two were melanocytoma of intermediate grade and remaining one was melanocytoma. On histopathology, melanocytoma and melanoma both displayed sheets of well-differentiated melanocytes having round to oval nuclei with finely dispersed chromatin, occasional single eosinophilic nucleoli and a moderate amount of cytoplasm with abundant granular melanin pigment. The absence of mitosis and macronucleoli was noticed in melanocytoma while melanoma showed frequent mitosis and macronucleoli. On immunohistochemistry, both showed diffuse strong HMB45 and S-100 immunopositivity. Conclusion: Primary melanocytic tumors of CNS are rare and predominantly seen in males. It is important to differentiate melanoma from melanocytoma as prognosis of later is good.Keywords: melanocytoma, melanoma, brain tumor, melanin
Procedia PDF Downloads 2342915 A Review of Deep Learning Methods in Computer-Aided Detection and Diagnosis Systems based on Whole Mammogram and Ultrasound Scan Classification
Authors: Ian Omung'a
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Breast cancer remains to be one of the deadliest cancers for women worldwide, with the risk of developing tumors being as high as 50 percent in Sub-Saharan African countries like Kenya. With as many as 42 percent of these cases set to be diagnosed late when cancer has metastasized and or the prognosis has become terminal, Full Field Digital [FFD] Mammography remains an effective screening technique that leads to early detection where in most cases, successful interventions can be made to control or eliminate the tumors altogether. FFD Mammograms have been proven to multiply more effective when used together with Computer-Aided Detection and Diagnosis [CADe] systems, relying on algorithmic implementations of Deep Learning techniques in Computer Vision to carry out deep pattern recognition that is comparable to the level of a human radiologist and decipher whether specific areas of interest in the mammogram scan image portray abnormalities if any and whether these abnormalities are indicative of a benign or malignant tumor. Within this paper, we review emergent Deep Learning techniques that will prove relevant to the development of State-of-The-Art FFD Mammogram CADe systems. These techniques will span self-supervised learning for context-encoded occlusion, self-supervised learning for pre-processing and labeling automation, as well as the creation of a standardized large-scale mammography dataset as a benchmark for CADe systems' evaluation. Finally, comparisons are drawn between existing practices that pre-date these techniques and how the development of CADe systems that incorporate them will be different.Keywords: breast cancer diagnosis, computer aided detection and diagnosis, deep learning, whole mammogram classfication, ultrasound classification, computer vision
Procedia PDF Downloads 932914 State, Public Policies, and Rights: Public Expenditure and Social and Welfare Policies in America, as Opposed to Argentina
Authors: Mauro Cristeche
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This paper approaches the intervention of the American State in the social arena and the modeling of the rights system from the Argentinian experience, by observing the characteristics of its federal budgetary system, the evolution of social public spending and welfare programs in recent years, labor and poverty statistics, and the changes on the labor market structure. The analysis seeks to combine different methodologies and sources: in-depth interviews with specialists, analysis of theoretical and mass-media material, and statistical sources. Among the results, it could be mentioned that the tendency to state interventionism (what has been called ‘nationalization of social life’) is quite evident in the United States, and manifests itself in multiple forms. The bibliography consulted, and the experts interviewed pointed out this increase of the state presence in historical terms (beyond short-term setbacks) in terms of increase of public spending, fiscal pressure, public employment, protective and control mechanisms, the extension of welfare policies to the poor sectors, etc. In fact, despite the significant differences between both countries, the United States and Argentina have common patterns of behavior in terms of the aforementioned phenomena. On the other hand, dissimilarities are also important. Some of them are determined by each country's own political history. The influence of political parties on the economic model seems more decisive in the United States than in Argentina, where the tendency to state interventionism is more stable. The centrality of health spending is evident in America, while in Argentina that discussion is more concentrated in the social security system and public education. The biggest problem of the labor market in the United States is the disqualification as a consequence of the technological development while in Argentina it is a result of its weakness. Another big difference is the huge American public spending on Defense. Then, the more federal character of the American State is also a factor of differential analysis against a centralized Argentine state. American public employment (around 10%) is comparatively quite lower than the Argentinian (around 18%). The social statistics show differences, but inequality and poverty have been growing as a trend in the last decades in both countries. According to public rates, poverty represents 14% in The United States and 33% in Argentina. American public spending is important (welfare spending and total public spending represent around 12% and 34% of GDP, respectively), but a bit lower than Latin-American or European average). In both cases, the tendency to underemployment and disqualification unemployment does not assume a serious gravity. Probably one of the most important aspects of the analysis is that private initiative and public intervention are much more intertwined in the United States, which makes state intervention more ‘fuzzy’, while in Argentina the difference is clearer. Finally, the power of its accumulation of capital and, more specifically, of the industrial and services sectors in the United States, which continues to be the engine of the economy, express great differences with Argentina, supported by its agro-industrial power and its public sector.Keywords: state intervention, welfare policies, labor market, system of rights, United States of America
Procedia PDF Downloads 1312913 Alternate Methods to Visualize 2016 U.S. Presidential Election Result
Authors: Hong Beom Hur
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Politics in America is polarized. The best illustration of this is the 2016 presidential election result map. States with megacities like California, New York, Illinois, Virginia, and others are marked blue to signify the color of the Democratic party. States located in inland and south like Texas, Florida, Tennesse, Kansas and others are marked red to signify the color of the Republican party. Such a stark difference between two colors, red and blue, combined with geolocations of each state with their borderline remarks one central message; America is divided into two colors between urban Democrats and rural Republicans. This paper seeks to defy the visualization by pointing out its limitations and search for alternative ways to visualize the 2016 election result. One such limitation is that geolocations of each state and state borderlines limit the visualization of population density. As a result, the election result map does not convey the fact that Clinton won the popular vote and only accentuates the voting patterns of urban and rural states. The paper seeks whether an alternative narrative can be observed by factoring in the population number into the size of each state and manipulating the state borderline according to the normalization. Yet another alternative narrative may be reached by factoring the size of each state by the number of the electoral college of each state by voting and visualize the number. Other alternatives will be discussed but are not implemented in visualization. Such methods include dividing the land of America into about 120 million cubes each representing a voter or by the number of whole population 300 million cubes. By exploring these alternative methods to visualize the politics of the 2016 election map, the public may be able to question whether it is possible to be free from the narrative of the divide-conquer when interpreting the election map and to look at both parties as a story of the United States of America.Keywords: 2016 U.S. presidential election, data visualization, population scale, geo-political
Procedia PDF Downloads 1212912 Using Squeezed Vacuum States to Enhance the Sensitivity of Ground Based Gravitational Wave Interferometers beyond the Standard Quantum Limit
Authors: Giacomo Ciani
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This paper reviews the impact of quantum noise on modern gravitational wave interferometers and explains how squeezed vacuum states are used to push the noise below the standard quantum limit. With the first detection of gravitational waves from a pair of colliding black holes in September 2015 and subsequent detections including that of gravitational waves from a pair of colliding neutron stars, the ground-based interferometric gravitational wave observatories LIGO and VIRGO have opened the era of gravitational-wave and multi-messenger astronomy. Improving the sensitivity of the detectors is of paramount importance to increase the number and quality of the detections, fully exploiting this new information channel about the universe. Although still in the commissioning phase and not at nominal sensitivity, these interferometers are designed to be ultimately limited by a combination of shot noise and quantum radiation pressure noise, which define an envelope known as the standard quantum limit. Despite the name, this limit can be beaten with the use of advanced quantum measurement techniques, with the use of squeezed vacuum states being currently the most mature and promising. Different strategies for implementation of the technology in the large-scale detectors, in both their frequency-independent and frequency-dependent variations, are presented, together with an analysis of the main technological issues and expected sensitivity gain.Keywords: gravitational waves, interferometers, squeezed vacuum, standard quantum limit
Procedia PDF Downloads 1512911 Responsibility of States in Air Traffic Management: Need for International Unification
Authors: Nandini Paliwal
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Since aviation industry is one of the fastest growing sectors of the world economy, states depend on the air transport industry to maintain or stimulate economic growth. It significantly promotes and contributes to the economic well-being of every nation as well as world in general. Because of the continuous and rapid growth in civil aviation, it is inevitably leading to congested skies, flight delays and most alarmingly, a decrease in the safety of air navigation facilities. Safety is one of the most important concerns of aviation industry that has been unanimously recognised across the whole world. The available capacity of the air navigation system is not sufficient for the demand that is being generated. It has been indicated by forecast that the current growth in air traffic has the potential of causing delays in 20% of flights by 2020 unless changes are brought in the current system. Therefore, a safe, orderly and expeditious air navigation system is needed at the national and global levels, which, requires the implementation of an air traffic management (hereinafter referred as ‘ATM’) system to ensure an optimum flow of air traffic by utilising and enhancing capabilities provided by technical advances. The objective of this paper is to analyse the applicability of national regulations in case of liability arising out of air traffic management services and whether the current legal regime is sufficient to cover multilateral agreements including the Single European Sky regulations. In doing so, the paper will examine the international framework mainly the Article 28 of the Chicago Convention and its relevant annexes to determine the responsibility of states for providing air navigation services. Then, the paper will discuss the difference between the concept of responsibility and liability under the air law regime and how states might claim sovereign immunity for the functions of air traffic management. Thereafter, the paper will focus on the cross border agreements including the bilateral and multilateral agreements. In the end, the paper will address the scheme of Single European Sky and the need for an international convention dealing with the liability of air navigation service providers. The paper will conclude with some suggestions for unification of the laws at an international level dealing with liability of air navigation service providers and the requirement of enhanced co-operation among states in order to keep pace with technological advances.Keywords: air traffic management, safety, single European sky, co-operation
Procedia PDF Downloads 1702910 The Impact of the Great Irish Famine on Irish Mass Migration to the United States at the Turn of the Twentieth Century
Authors: Gayane Vardanyan, Gaia Narciso, Battista Severgnini
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This paper investigates the long-run impact of the Great Irish Famine on emigration from Ireland at the turn of the twentieth century. To do it we combine the 1901 and the 1911 Irish Census data sets with the Ellis Island Administrative Records on Irish migrants to the United States. We find that the migrants were more likely to be Catholic, literate, unmarried, young and Gaelic speaking compared to the ones that stay. Running individual level specifications, our preliminary findings suggest that being born in a place where the Famine was more severe increases the probability of becoming a migrant in the long-run. We also intend to explore the mechanisms through which this impact occurs.Keywords: Great Famine, mass migration, long-run impact, mechanisms
Procedia PDF Downloads 2382909 Social Influences on Americans' Mask-Wearing Behavior during COVID-19
Authors: Ruoya Huang, Ruoxian Huang, Edgar Huang
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Based on a convenience sample of 2,092 participants from across all 50 states of the United States, a survey was conducted to explore Americans’ mask-wearing behaviors during COVID-19 according to their political convictions, religious beliefs, and ethnic cultures from late July to early September, 2020. The purpose of the study is to provide evidential support for government policymaking so as to drive up more effective public policies by taking into consideration the variance in these social factors. It was found that the respondents’ party affiliation or preference, religious belief, and ethnicity, in addition to their health condition, gender, level of concern of contracting COVID-19, all affected their mask-wearing habits both in March, the initial coronavirus outbreak stage, and in August, when mask-wearing had been made mandatory by state governments. The study concludes that pandemic awareness campaigns must be run among all citizens, especially among African Americans, Muslims, and Republicans, who have the lowest rates of wearing masks, in order to protect themselves and others. It is recommended that complementary cognitive bias awareness programs should be implemented in non-Black and non-Muslim communities to eliminate social concerns that deter them from wearing masks.Keywords: COVID-19 pandemic, ethnicity, mask-wearing, policymaking implications, political affiliations, religious beliefs, United States
Procedia PDF Downloads 2342908 Endometriosis-Associated Ovarian Cancer: Clinical and Pathological Pattern
Authors: I. Ramalho, S. Campos, M. Dias
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Introduction: Endometriosis may play a role in the pathogenesis of ovarian cancer (OC), however, the risk and prognosis have not been well established. The association between these two pathologies could have an important impact on prevention and early diagnosis of OC. Objective: To analyze the prevalence of endometriosis associated ovarian cancer and related clinical, epidemiological and histopathological issues. Design: We conducted a retrospective case series analysis of patients diagnosed with endometriosis and ovarian cancer in the Gynecology Department of Coimbra University Hospital Center since 2006 to 2015. Methods: We collected data from women diagnosed with ovarian cancer, with anatomopathology records reporting findings of endometriosis in ovarian cancer patients. Patients were retrieved from the pathological records and appropriate medical records were retrospectively reviewed. Statistical analysis was performed using SPSS 22.0. Results: Histological evidence of endometriosis was found in 17 out of 261 patients diagnosed with ovarian cancer (OC) (6.51%). The most usual symptoms were pelvic pain, abdominal distension, asthenia, ascites, weight loss and nausea. Mean age at diagnosis was 61.2 ± 15.1, 41-86 years old, 33.3% were pre-menopausal patients and cancer stage distribution was predominantly stage I (31.3%) and stage III (56.3%). OC occurred unilaterally in 14 patients and 2 patients were diagnosed with a synchronous ovarian and endometrial cancer. Regarding histological type, 10 OC were classified as clear cell carcinoma (CCC), 4 endometrioid carcinomas (EC) and 3 mixed type (clear cell and endometrioid). Four ovarian carcinomas presumably arose from endometriomas: 3 CCC and 1 EC. Conclusions: In accordance with previous studies, clear cell was the most common pathological type in endometriotic patients, followed by endometrioid carcinomas, and two rare synchronous ovarian and endometrial carcinomas were registered. Although endometriosis association to OC is uncommon, endometriosis should be managed with special care in order to early diagnosis.Keywords: endometriosis, histology, observational study, ovarian cancer
Procedia PDF Downloads 2292907 Epstein-Barr Virus-associated Diseases and TCM Syndromes Types: In Search for Correlation
Authors: Xu Yifei, Le Yining, Yang Qingluan, Tu Yanjie
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Objective: This study aims to investigate the distribution features of Traditional Chinese Medicine (TCM) syndromes and syndrome elements in Epstein-Barr virus-associated diseases and then explores the relations between TCM syndromes or syndrome elements and laboratory indicators of Epstein-Barr virus-associated diseases. Methods: A cross-sectional study of 70 patients with EBV infection was described. We assessed the diagnostic information and laboratory indicators of these patients from Huashan Hospital Affiliated to Fudan University between November 2017 and July 2019. The disease diagnosis and syndrome differentiation were based on the diagnostic criteria of EBV-associated diseases and the theory of TCM respectively. Confidence correlation analysis, logistic regression analysis, cluster analysis, and the Sankey diagram were used to analyze the correlation between the data. Results: The differentiation of the 4 primary TCM syndromes in the collected patients was correlated with the indexes of immune function, liver function, inflammation, and anemia, especially the relationship between Qifen syndrome and high lactic acid dehydrogenase level. The common 11 TCM syndrome elements were associated with the increased CD3+ T cell rate, low hemoglobin level, high procalcitonin level, high lactic acid dehydrogenase level, and low albumin level. Conclusion: The changes in immune function indexes, procalcitonin, and liver function-related indexes in patients with EBV-associated diseases were consistent with the evolution law of TCM syndromes. This study provides a reference for judging the pathological stages of these kinds of diseases, predicting their prognosis, and guiding subsequent treatment strategies based on TCM syndrome type.Keywords: EBV-associated diseases, traditional Chinese medicine syndrome, syndrome element, diagnostics
Procedia PDF Downloads 1062906 Formation of Miniband Structure in Dimer Fibonacci GaAs/Ga1-XAlXAs Superlattices
Authors: Aziz Zoubir, Sefir Yamina, Djelti Redouan, Bentata Samir
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The effect of a uniform electric field across multibarrier systems (GaAs/AlxGa1-xAs) is exhaustively explored by a computational model using exact Airy function formalism and the transfer-matrix technique. In the case of biased Dimer Fibonacci Height Barrier superlattices (DFHBSL) structure a strong reduction in transmission properties was observed and the width of the miniband structure linearly decreases with the increase of the applied bias. This is due to the confinement of the states in the miniband structure, which becomes increasingly important (Wannier-Stark effect).Keywords: Dimer Fibonacci Height Barrier superlattices, singular extended states, exact Airy function, transfer matrix formalism
Procedia PDF Downloads 5092905 Integration of an Augmented Reality System for the Visualization of the HRMAS NMR Analysis of Brain Biopsy Specimens Using the Brainlab Cranial Navigation System
Authors: Abdelkrim Belhaoua, Jean-Pierre Radoux, Mariana Kuras, Vincent Récamier, Martial Piotto, Karim Elbayed, François Proust, Izzie Namer
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This paper proposes an augmented reality system dedicated to neurosurgery in order to assist the surgeon during an operation. This work is part of the ExtempoRMN project (Funded by Bpifrance) which aims at analyzing during a surgical operation the metabolic content of tumoral brain biopsy specimens by HRMAS NMR. Patients affected with a brain tumor (gliomas) frequently need to undergo an operation in order to remove the tumoral mass. During the operation, the neurosurgeon removes biopsy specimens using image-guided surgery. The biopsy specimens removed are then sent for HRMAS NMR analysis in order to obtain a better diagnosis and prognosis. Image-guided refers to the use of MRI images and a computer to precisely locate and target a lesion (abnormal tissue) within the brain. This is performed using preoperative MRI images and the BrainLab neuro-navigation system. With the patient MRI images loaded on the Brainlab Cranial neuro-navigation system in the operating theater, surgeons can better identify their approach before making an incision. The Brainlab neuro-navigation tool tracks in real time the position of the instruments and displays their position on the patient MRI data. The results of the biopsy analysis by 1H HRMAS NMR are then sent back to the operating theater and superimposed on the 3D localization system directly on the MRI images. The method we have developed to communicate between the HRMAS NMR analysis software and Brainlab makes use of a combination of C++, VTK and the Insight Toolkit using OpenIGTLink protocol.Keywords: neuro-navigation, augmented reality, biopsy, BrainLab, HR-MAS NMR
Procedia PDF Downloads 3642904 Mapping Social and Natural Hazards: A Survey of Potential for Managed Retreat in the United States
Authors: Karim Ahmed
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The purpose of this study was to investigate how factoring the impact of natural disasters beyond flooding would affect managed retreat policy eligibility in the United States. For the study design, a correlation analysis method compared weighted measures of flooding and other natural disasters (e.g., wildfires, tornadoes, heatwaves, etc.) to CBSA Populated areas, the prevalence of cropland, and relative poverty on a county level. The study found that the vast majority of CBSAs eligible for managed retreat programs under a policy inclusive of non-flooding events would have already been covered by flood-only managed retreat policies. However, it is noteworthy that a majority of those counties that are not covered by a flood-only managed retreat policy have high rates of poverty and are either heavily populated and/or agriculturally active. The correlation is particularly strong between counties that are subject to multiple natural hazards and those that have both high rates of relative poverty and cropland prevalence. There is currently no managed retreat policy for agricultural land in the United States despite the environmental implications and food supply chain vulnerabilities related to at-risk cropland. The findings of this study suggest both that such a policy should be created and, when it is, that special attention should be paid to non-flood natural disasters affecting agricultural areas. These findings also reveal that, while current flood-based policies in the United States serve many areas that do need access to managed retreat funding and implementation, other vulnerable areas are overlooked by this approach. These areas are often deeply impoverished and are therefore particularly vulnerable to natural disaster; if and when those disasters do occur, these areas are often less financially prepared to recover or retreat from the disaster’s advance and, due to the limitations of the current policies discussed above, are less able to take the precautionary measures necessary to mitigate their risk.Keywords: flood, hazard, land use, managed retreat, wildfire
Procedia PDF Downloads 1262903 Medical Diagnosis of Retinal Diseases Using Artificial Intelligence Deep Learning Models
Authors: Ethan James
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Over one billion people worldwide suffer from some level of vision loss or blindness as a result of progressive retinal diseases. Many patients, particularly in developing areas, are incorrectly diagnosed or undiagnosed whatsoever due to unconventional diagnostic tools and screening methods. Artificial intelligence (AI) based on deep learning (DL) convolutional neural networks (CNN) have recently gained a high interest in ophthalmology for its computer-imaging diagnosis, disease prognosis, and risk assessment. Optical coherence tomography (OCT) is a popular imaging technique used to capture high-resolution cross-sections of retinas. In ophthalmology, DL has been applied to fundus photographs, optical coherence tomography, and visual fields, achieving robust classification performance in the detection of various retinal diseases including macular degeneration, diabetic retinopathy, and retinitis pigmentosa. However, there is no complete diagnostic model to analyze these retinal images that provide a diagnostic accuracy above 90%. Thus, the purpose of this project was to develop an AI model that utilizes machine learning techniques to automatically diagnose specific retinal diseases from OCT scans. The algorithm consists of neural network architecture that was trained from a dataset of over 20,000 real-world OCT images to train the robust model to utilize residual neural networks with cyclic pooling. This DL model can ultimately aid ophthalmologists in diagnosing patients with these retinal diseases more quickly and more accurately, therefore facilitating earlier treatment, which results in improved post-treatment outcomes.Keywords: artificial intelligence, deep learning, imaging, medical devices, ophthalmic devices, ophthalmology, retina
Procedia PDF Downloads 1812902 Quantum Coherence Sets the Quantum Speed Limit for Mixed States
Authors: Debasis Mondal, Chandan Datta, S. K. Sazim
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Quantum coherence is a key resource like entanglement and discord in quantum information theory. Wigner- Yanase skew information, which was shown to be the quantum part of the uncertainty, has recently been projected as an observable measure of quantum coherence. On the other hand, the quantum speed limit has been established as an important notion for developing the ultra-speed quantum computer and communication channel. Here, we show that both of these quantities are related. Thus, cast coherence as a resource to control the speed of quantum communication. In this work, we address three basic and fundamental questions. There have been rigorous attempts to achieve more and tighter evolution time bounds and to generalize them for mixed states. However, we are yet to know (i) what is the ultimate limit of quantum speed? (ii) Can we measure this speed of quantum evolution in the interferometry by measuring a physically realizable quantity? Most of the bounds in the literature are either not measurable in the interference experiments or not tight enough. As a result, cannot be effectively used in the experiments on quantum metrology, quantum thermodynamics, and quantum communication and especially in Unruh effect detection et cetera, where a small fluctuation in a parameter is needed to be detected. Therefore, a search for the tightest yet experimentally realisable bound is a need of the hour. It will be much more interesting if one can relate various properties of the states or operations, such as coherence, asymmetry, dimension, quantum correlations et cetera and QSL. Although, these understandings may help us to control and manipulate the speed of communication, apart from the particular cases like the Josephson junction and multipartite scenario, there has been a little advancement in this direction. Therefore, the third question we ask: (iii) Can we relate such quantities with QSL? In this paper, we address these fundamental questions and show that quantum coherence or asymmetry plays an important role in setting the QSL. An important question in the study of quantum speed limit may be how it behaves under classical mixing and partial elimination of states. This is because this may help us to choose properly a state or evolution operator to control the speed limit. In this paper, we try to address this question and show that the product of the time bound of the evolution and the quantum part of the uncertainty in energy or quantum coherence or asymmetry of the state with respect to the evolution operator decreases under classical mixing and partial elimination of states.Keywords: completely positive trace preserving maps, quantum coherence, quantum speed limit, Wigner-Yanase Skew information
Procedia PDF Downloads 3532901 Access to Justice for Persons with Intellectual Disabilities in Indonesia: Case and Problem in Indonesian Criminal Justice System
Authors: Fines Fatimah, SH. MH.
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Indonesia is one of the countries that has ratified the UNCRPD (United Nations Convention on the Rights of Persons with Disabilities). The ratification of this convention brings consequences on the adjustment of national legislation with the UNCRPD convention, where this ratification at the same time is a measure in the eyes of the international community that a state party could be consistent with the issues and problems of disability. Persons with disabilities often have little access to justice when they are forced to deal with the criminal justice system. Pursuit of justice through litigation are often not in their favor, therefore without any awareness of law enforcement/awareness of disability will further complicate access to justice for persons with disabilities. Under Article 13 of the UNCRPD, it appeared that the convention requires ratifying states to guarantee equal opportunity and treatment in justice for persons with disabilities. The States should also ensure that any judicial rules must be adapted to the circumstances of persons with disabilities so that people with disabilities can fully participate in all stages of the trial court and, for example, as a witness. Finally, the state must provide training to understand these persons with disabilities (for those who work in the judiciary institution such as police or prison officials). Further, this paper aims to describe problem faced by persons with intellectual disabilities to access justice in Indonesian Criminal Justice System. This paper tries to find and propose the alternative solutions to promote the quality of law enforcement in Indonesia, especially for persons with intellectual disabilities.Keywords: access to justice, Indonesian criminal justice system, intellectual disability, ratifying states
Procedia PDF Downloads 5162900 Low Volume High Intensity Interval Training Effect on Liver Enzymes in Chronic Hepatitis C Patients
Authors: Aya Gamal Khattab
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Chronic infection with the hepatitis C virus (HCV) is now the leading cause of liver-related morbidity and mortality; Currently, alanine aminotransferase ALT measurement is not only widely used in detecting the incidence, development, and prognosis of liver disease with obvious clinical symptoms, but also provides reference on screening the overall health status during health check-ups. Exercise is a low-cost, reliable and sustainable therapy for many chronic diseases. Low-volume high intensity interval training HIT is time efficient while also having wider application to different populations including people at risk for chronic inflammatory diseases. Purpose of this study was to investigate the effect of low volume high intensity interval training on ALT, AST in HCV patients. All practical work was done in outpatient physiotherapy clinic of Suez Canal Authority Hospitals. Forty patients both gender (27 male, 13 female), age ranged (40-60) years old submitted to low volume high intensity interval training on treadmill for two months three sessions per week. Each session consisting of five min warming up, two bouts for 10 min each bout consisting of 30 sec - 1 min of high intensity (75%-85%) HRmax then two to four min active recovery at intensity (40%-60%) HRmax, so the sum of high intensity intervals was one to two min for each session and four to eight min active recovery, and ends with five min cooling down. ALT and AST were measured before starting exercise session and 2 months later after finishing the total exercise sessions through blood samples. Results showed significant decrease in ALT, AST with improvement percentage (18.85%), (23.87%) in the study, so the study concluded that low volume high intensity interval training had a significant effect in lowering the level of circulating liver enzymes (ALT, AST) which means protection of hepatic cells and restoration of its function.Keywords: alanine aminotransferase (ALT), aspartate aminotransferase (AST), hepatitis C (HCV), low volume high intensity interval training
Procedia PDF Downloads 2992899 Adenoid Cystic Carcinoma of the Lacrimal Gland (About a Case)
Authors: H. Hadjeris, R. B. Ghoul, Lekhlaf, M. Nebbal
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Introduction: Adenoid cystic carcinomas of the lacrimal gland or orbital cylindroma constitute the second cause of epithelial tumors of this gland. It is a malignant tumor usually developed at the expense of the salivary glands; its orbital location is exceptional. It is a rare clinical entity, formidable by its malignancy and local aggressiveness; the recurrence rate is high. Materials and methods: Clinical case: 63 years old woman who presents with irreducible no pulsatile painful left exophthalmos with inflammatory chemosis and a decrease in visual acuity with a moderate intracranial hypertension syndrome that has been evolving for 03 months. Antecedent; a biopsy of the tumor was made; the histological examination was in favor of an adenoid cystic carcinoma of the lacrimal gland. Lesion assessment: computed tomography and brain MRI: show an intra and extra-conical mass; with sinus (ethmoido-frontal) and cerebral (left frontal) extension strongly enhanced after injection of contrast product surrounded by edema around the lesion, associated with left frontal bone lysis extension assessment: unremarkable treatment: Patient operated by left frontotemporal approach, a total exenteration was performed with macroscopically complete excision of the frontal lesion and wide frontal craniectomy with craniofacial reconstruction, followed by complementary radiotherapy. Results: The patient was seen again after 3 months in consultation; she does not present any signs in favor of a recurrence. Conclusion: Adenoid cystic carcinomas of the lacrimal gland are rare malignant tumors; they are very infiltrating and invasive. The prognosis is strongly linked to the treatment time.Keywords: adenoid cystic, lacrimal gland, orbital location, fronto-temporal approac
Procedia PDF Downloads 712898 The Neoliberal Social-Economic Development and Values in the Baltic States
Authors: Daiva Skuciene
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The Baltic States turned to free market and capitalism after independency. The new socioeconomic system, democracy and priorities about the welfare of citizens formed. The researches show that Baltic states choose the neoliberal development. Related to this neoliberal path, a few questions arouse: how do people evaluate the results of such policy and socioeconomic development? What are their priorities? And what are the values of the Baltic societies that support neoliberal policy? The purpose of this research – to analyze the socioeconomic context and the priorities and the values of the Baltics societies related to neoliberal regime. The main objectives are: firstly, to analyze the neoliberal socioeconomic features and results; secondly, to analyze people opinions and priorities about the results of neoliberal development; thirdly, to analyze the values of the Baltic societies related to the neoliberal policy. For the implementation of the purpose and objectives, the comparative analyses among European countries are used. The neoliberal regime was defined through two indicators: the taxes on capital income and expenditures on social protection. The socioeconomic outcomes of neoliberal welfare regime are defined through the Gini inequality and at risk of the poverty rate. For this analysis, the data of 2002-2013 of Eurostat were used. For the analyses of opinion about inequality and preferences on society, people want to live in, the preferences for distribution between capital and wages in enterprise data of Eurobarometer in 2010-2014 and the data of representative survey in the Baltic States in 2016 were used. The justice variable was selected as a variable reflecting the evaluation of socioeconomic context and analyzed using data of Eurobarometer 2006-2015. For the analyses of values were selected: solidarity, equality, and individual responsibility. The solidarity, equality was analyzed using data of Eurobarometer 2006-2015. The value “individual responsibility” was examined by opinions about reasons of inequality and poverty. The survey of population in the Baltic States in 2016 and data of Eurobarometer were used for this aim. The data are ranged in descending order for understanding the position of opinion of people in the Baltic States among European countries. The dynamics of indicators is also provided to examine stability of values. The main findings of the research are that people in the Baltics are dissatisfied with the results of the neoliberal socioeconomic development, they have priorities for equality and justice, but they have internalized the main neoliberal narrative- individual responsibility. The impact of socioeconomic context on values is huge, resulting in a change in quite stable opinions and values during the period of the financial crisis.Keywords: neoliberal, inequality and poverty, solidarity, individual responsibility
Procedia PDF Downloads 2562897 The Current Ways of Thinking Mild Traumatic Brain Injury and Clinical Practice in a Trauma Hospital: A Pilot Study
Authors: P. Donnelly, G. Mitchell
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Traumatic Brain Injury (TBI) is a major contributor to the global burden of disease; despite its ubiquity, there is significant variation in diagnosis, prognosis, and treatment between clinicians. This study aims to examine the spectrum of approaches that currently exist at a Level 1 Trauma Centre in Australasia by surveying Emergency Physicians and Neurosurgeons on those aspects of mTBI. A pilot survey of 17 clinicians (Neurosurgeons, Emergency Physicians, and others who manage patients with mTBI) at a Level 1 Trauma Centre in Brisbane, Australia, was conducted. The objective of this study was to examine the importance these clinicians place on various elements in their approach to the diagnosis, prognostication, and treatment of mTBI. The data were summarised, and the descriptive statistics reported. Loss of consciousness and post-traumatic amnesia were rated as the most important signs or symptoms in diagnosing mTBI (median importance of 8). MRI was the most important imaging modality in diagnosing mTBI (median importance of 7). ‘Number of the Previous TBIs’ and Intracranial Injury on Imaging’ were rated as the most important elements for prognostication (median importance of 9). Education and reassurance were rated as the most important modality for treating mTBI (median importance of 7). There was a statistically insignificant variation between the specialties as to the importance they place on each of these components. In this Australian tertiary trauma center, there appears to be variation in how clinicians approach mTBI. This study is underpowered to state whether this is between clinicians within a specialty or a trend between specialties. This variation is worthwhile in investigating as a step toward a unified approach to diagnosing, prognosticating, and treating this common pathology.Keywords: mild traumatic brain injury, adult, clinician, survey
Procedia PDF Downloads 1302896 The First Tendency in Foreign Policy: Theories, Motives, and Effects
Authors: Djehich Mohamed Yousri
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In this paper, we explore the extent to which states seek to promote regional foreign policy. More specifically, the analytical feasibility is to find out exactly what countries seek to export, and how they have used their relations and foreign policies to enhance cooperation with other countries. The first part discusses the development of regional interests and theoretical approaches that attempted to explain the push for regionalism in the field of foreign policy. The second part of the paper presents the motives and mechanisms through which states spread the idea of regionalism in making foreign policy. Finally, we assess the implications of regionalism for the nature and practice of foreign policy, particularly with regard to the gains or constraints to which various actors are exposed in their regional endeavors. We conclude with some considerations that indicate that strengthening regionalism has become an additional and real program in the field of foreign policy analysis.Keywords: foreign policy, collective foreign policy, regionalization and foreign policy, regional foreign policy, foreign affairs
Procedia PDF Downloads 2472895 The Prognostic Prediction Value of Positive Lymph Nodes Numbers for the Hypopharyngeal Squamous Cell Carcinoma
Authors: Wendu Pang, Yaxin Luo, Junhong Li, Yu Zhao, Danni Cheng, Yufang Rao, Minzi Mao, Ke Qiu, Yijun Dong, Fei Chen, Jun Liu, Jian Zou, Haiyang Wang, Wei Xu, Jianjun Ren
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We aimed to compare the prognostic prediction value of positive lymph node number (PLNN) to the American Joint Committee on Cancer (AJCC) tumor, lymph node, and metastasis (TNM) staging system for patients with hypopharyngeal squamous cell carcinoma (HPSCC). A total of 826 patients with HPSCC from the Surveillance, Epidemiology, and End Results database (2004–2015) were identified and split into two independent cohorts: training (n=461) and validation (n=365). Univariate and multivariate Cox regression analyses were used to evaluate the prognostic effects of PLNN in patients with HPSCC. We further applied six Cox regression models to compare the survival predictive values of the PLNN and AJCC TNM staging system. PLNN showed a significant association with overall survival (OS) and cancer-specific survival (CSS) (P < 0.001) in both univariate and multivariable analyses, and was divided into three groups (PLNN 0, PLNN 1-5, and PLNN>5). In the training cohort, multivariate analysis revealed that the increased PLNN of HPSCC gave rise to significantly poor OS and CSS after adjusting for age, sex, tumor size, and cancer stage; this trend was also verified by the validation cohort. Additionally, the survival model incorporating a composite of PLNN and TNM classification (C-index, 0.705, 0.734) performed better than the PLNN and AJCC TNM models. PLNN can serve as a powerful survival predictor for patients with HPSCC and is a surrogate supplement for cancer staging systems.Keywords: hypopharyngeal squamous cell carcinoma, positive lymph nodes number, prognosis, prediction models, survival predictive values
Procedia PDF Downloads 1542894 A Comparison of Clinical and Pathological TNM Staging in a COVID-19 Era
Authors: Sophie Mills, Leila L. Touil, Richard Sisson
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Introduction: The TNM classification is the global standard for the staging of head and neck cancers. Accurate clinical-radiological staging of tumours (cTNM) is essential to predict prognosis, facilitate surgical planning and determine the need for other therapeutic modalities. This study aims to determine the accuracy of pre-operative cTNM staging using pathological TNM (pTNM) and consider possible causes of TNM stage migration, noting any variation throughout the COVID-19 pandemic. Materials and Methods: A retrospective cohort study examined records of patients with surgical management of head and neck cancer at a tertiary head and neck centre from November 2019 to November 2020. Data was extracted from Somerset Cancer Registry and histopathology reports. cTNM and pTNM were compared before and during the first wave of COVID-19, as well as with other potential prognostic factors such as tumour site and tumour stage. Results: 119 cases were identified, of which 52.1% (n=62) were male, and 47.9% (n=57) were female with a mean age of 67 years. Clinical and pathological staging differed in 54.6% (n=65) of cases. Of the patients with stage migration, 40.4% (n=23) were up-staged and 59.6% (n=34) were down-staged compared with pTNM. There was no significant difference in the accuracy of cTNM staging compared with age, sex, or tumour site. There was a statistically highly significant (p < 0.001) correlation between cTNM accuracy and tumour stage, with the accuracy of cTNM staging decreasing with the advancement of pTNM staging. No statistically significant variation was noted between patients staged prior to and during COVID-19. Conclusions: Discrepancies in staging can impact management and outcomes for patients. This study found that the higher the pTNM, the more likely stage migration will occur. These findings are concordant with the oncology literature, which highlights the need to improve the accuracy of cTNM staging for more advanced tumours.Keywords: COVID-19, head and neck cancer, stage migration, TNM staging
Procedia PDF Downloads 1092893 Rich 3-Tori Dynamics in Small-Aspect-Ratio Highly Counter-Rotating Taylor-Couette Flow with Reversal of Spiraling Vortices
Authors: S. Altmeyer, B. Hof, F. Marques, J. M. Lopez
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We present numerical simulations concerning the reversal of spiraling vortices in short highly counter-rotating cylinders. Increasing the differential cylinder rotation results in global flow-inversion is which develops various different and complex flow dynamics of several quasi-periodic solutions that differ in their number of vortex cells in the bulk. The dynamics change from being dominated of the inner cylinder boundary layer with ’passive’ only responding outer one to be dominated by the outer cylinder boundary layer with only responding inner one. Solutions exist on either two or three tori invariant manifolds whereby they appear as symmetric or asymmetric states. We find for either moderate and high inner cylinder rotation speed the quasiperiodic flow to consist of only two vortex cells but differ as the vortices has opposite spiraling direction. These both flows live on 2-tori but differ in number of symmetries. While for the quasi-periodic flow (q^a_2) at lower rotation speed a pair of symmetrically related 2-tori T2 exists the quasi-periodic flow (q^s_2) at higher rotation speeds is symmetric living on a single 2-torus T2. In addition these both flows differ due to their dominant azimuthal m modes. The first is dominated by m=1 whereas for the latter m=3 contribution is largest. The 2-tori states are separated by a further quasi-periodic flow (q^a_3) living on pair of symmetrically related 3-tori T3. This flow offers a ’periodical’ competition between a two and three vortex cell states in the bulk. This flow is also an m=1 solution as for the quasiperiodic flows living on the pair of symmetrically-related 2-tori states. Moreover we find hysteresis resulting in coexisting regions of different quasiperiodic flows q^s_2 and q^a_3 with increasing and decreasing the differential rotation.Keywords: transition, bifurcation, torus, symmetries
Procedia PDF Downloads 3582892 Hampering The 'Right to Know': Consequences of the Excessive Interpretation of the Notion of Exemption from the Right to Information
Authors: Tomasz Lewinski
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The right to know becomes gradually recognised as an increasing number of states adopts national legislations regarding access to state-held information. Laws differ from each other in the scope of the right to information (hereinafter: RTI). In all regimes of RTI, there are exceptions from the general notion of the right. States’ authorities too often use exceptions to justify refusals to requests for state-held information. This paper sets out how states hamper RTI basing on the notion of exception and by not providing an effective procedure that could redress unlawful denials. This paper bases on two selected examples of RTI incorporation into the national legal regime, United Kingdom, and South Africa. It succinctly outlines the international standard given in Article 19 of the International Covenant on Civil and Political Rights (hereinafter: ICCPR) and its influence on the RTI in selected countries. It shortly demonstrates as a background to further analysis the Human Rights Committee’s jurisprudence and standards articulated by successive Special Rapporteurs on freedom of opinion and expression. Subsequently, it presents a brief comparison of these standards with the regional standards, namely the African Charter on Human and Peoples' Rights and the European Convention on Human Rights. It critically discusses the regimes of exceptions in RTI legislations in respective national laws. It shows how excessive these regimes are, what implications they have for the transparency in general. Also, the objective is to divide exceptions enumerated in legislations of selected states in relation to exceptions provided in Article 19 of the ICCPR. Basing on the established division of exceptions by its natures, it compares both regimes of exceptions related to the principle of national security. That is to compare jurisprudence of domestic courts, and overview practices of states’ authorities applied to RTI requests. The paper evaluates remedies available in legislations, including contexts of the length and costs of the subsequent proceedings. This provides a general assessment of the given mechanisms and present potential risks of its ineffectiveness. The paper relies on examination of the national legislations, comments of the credible non-governmental organisations (e.g. The Public's Right to Know Principles on Freedom of Information Legislation by the Article 19, The Tshwane Principles on National Security and the Right to Information), academics and also the research of the relevant judgements delivered by domestic and international courts. Conclusion assesses whether selected countries’ legislations go in line with international law and trends, whether the jurisprudence of the regional courts provide appropriate benchmarks for national courts to address RTI issues effectively. Furthermore, it identifies the largest disadvantages of current legislations and to what outcomes it leads in domestic courts jurisprudences. In the end, it provides recommendations and policy arguments for states to improve transparency and support local organisations in their endeavours to establish more transparent states and societies.Keywords: access to information, freedom of information, national security, right to know, transparency
Procedia PDF Downloads 2132891 Time-Evolving Wave Packet in Phase Space
Authors: Mitsuyoshi Tomiya, Kentaro Kawamura, Shoichi Sakamoto
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In chaotic billiard systems, scar-like localization has been found on time-evolving wave packet. We may call it the “dynamical scar” to separate it to the original scar in stationary states. It also comes out along the vicinity of classical unstable periodic orbits, when the wave packets are launched along the orbits, against the hypothesis that the waves become homogenous all around the billiard. Then time-evolving wave packets are investigated numerically in phase space. The Wigner function is adopted to detect the wave packets in phase space. The 2-dimensional Poincaré sections of the 4-dimensional phase space are introduced to clarify the dynamical behavior of the wave packets. The Poincaré sections of the coordinate (x or y) and the momentum (Px or Py) can visualize the dynamical behavior of the wave packets, including the behavior in the momentum degree also. For example, in “dynamical scar” states, a bit larger momentum component comes first, and then the a bit smaller and smaller components follow next. The sections made in the momentum space (Px or Py) elucidates specific trajectories that have larger contribution to the “dynamical scar” states. It is the fixed point observation of the momentum degrees at a specific fixed point(x0, y0) in the phase space. The accumulation are also calculated to search the “dynamical scar” in the Poincare sections. It is found the scars as bright spots in momentum degrees of the phase space.Keywords: chaotic billiard, Poincaré section, scar, wave packet
Procedia PDF Downloads 4522890 Retrospective Study on the Prognosis of Patients with New-Onset Atrial Fibrillation to Evaluate the Risk of Developing Occult Cancer in Absence of Concurrent Chronic Inflammatory Disease
Authors: Helen Huang, Francisco Javier Quesada Ocet, Blanca Quesada Oce, Javier Jimenez Bello, Victor Palanca Gil, Alba Cervero Rubio, Ana Paya Chaume, Alejandro Herreros-Pomares, Fernando Vidal-Vanaclocha, Rafael Paya Serrano, Aurelio Quesada Dorador, Monica Soliman
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Background: Cancer favors both the pro-inflammatory state and autonomic dysfunction, two important mechanisms in the genesis of AF. Atrial remodeling might be caused as a result of paraneoplastic conditions or the result of direct expression of neoplasia. Here, we hypothesize that cancer, through inflammatory mediators, may favor the appearance of AF and patients with the first episode of AF could have a higher risk of developing cancer. Method: Data was collected from patients who attended the emergency department of our hospital for the first episode of AF, diagnosed electrocardiographically, between 2010-2015 (n = 712). The minimum follow-up was 2 years, recording the appearance of cancer, total mortality, recurrences of AF and other events. Patients who developed cancer and those who did not during the 2 years after the onset of AF were compared, as well as with the incidence of cancer in Spain in 2012. Results: After 2 years, 35 patients (4.91%) were diagnosed with cancer, with an annual incidence of 2.45%. Hematological neoplasms were the most frequent (34.28%). The cancer group was older (76.68 +/-12.75 years vs 74.16 +/-12.71; p <0.05) and had fewer typical symptoms (palpitations) (33.38% vs 14.28% , p <0.05). The incidence of cancer in Spain during 2012 was 0.46%, much lower than our sample. When comparing the incidence by age, these differences were maintained both in those over 65 years of age and in those under 65 years of age (2.17% vs. 0.28%; 0.28% vs. 0.18% respectively). Discussion: Therefore, a high incidence of cancer in patients with the first episode of AF was observed (the annual incidence of 2.45% after the onset of AF is 6.1 times that of the general population). After the evaluation of patients with AF in their first detected episode, surveillance of the appearance of cancer should be considered in clinical practice.Keywords: cancer, cardiovascular outcomes, atrial fibrillation, inflammation
Procedia PDF Downloads 1472889 Connectomic Correlates of Cerebral Microhemorrhages in Mild Traumatic Brain Injury Victims with Neural and Cognitive Deficits
Authors: Kenneth A. Rostowsky, Alexander S. Maher, Nahian F. Chowdhury, Andrei Irimia
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The clinical significance of cerebral microbleeds (CMBs) due to mild traumatic brain injury (mTBI) remains unclear. Here we use magnetic resonance imaging (MRI), diffusion tensor imaging (DTI) and connectomic analysis to investigate the statistical association between mTBI-related CMBs, post-TBI changes to the human connectome and neurological/cognitive deficits. This study was undertaken in agreement with US federal law (45 CFR 46) and was approved by the Institutional Review Board (IRB) of the University of Southern California (USC). Two groups, one consisting of 26 (13 females) mTBI victims and another comprising 26 (13 females) healthy control (HC) volunteers were recruited through IRB-approved procedures. The acute Glasgow Coma Scale (GCS) score was available for each mTBI victim (mean µ = 13.2; standard deviation σ = 0.4). Each HC volunteer was assigned a GCS of 15 to indicate the absence of head trauma at the time of enrollment in our study. Volunteers in the HC and mTBI groups were matched according to their sex and age (HC: µ = 67.2 years, σ = 5.62 years; mTBI: µ = 66.8 years, σ = 5.93 years). MRI [including T1- and T2-weighted volumes, gradient recalled echo (GRE)/susceptibility weighted imaging (SWI)] and gradient echo (GE) DWI volumes were acquired using the same MRI scanner type (Trio TIM, Siemens Corp.). Skull-stripping and eddy current correction were implemented. DWI volumes were processed in TrackVis (http://trackvis.org) and 3D Slicer (http://www.slicer.org). Tensors were fit to DWI data to perform DTI, and tractography streamlines were then reconstructed using deterministic tractography. A voxel classifier was used to identify image features as CMB candidates using Microbleed Anatomic Rating Scale (MARS) guidelines. For each peri-lesional DTI streamline bundle, the null hypothesis was formulated as the statement that there was no neurological or cognitive deficit associated with between-scan differences in the mean FA of DTI streamlines within each bundle. The statistical significance of each hypothesis test was calculated at the α = 0.05 level, subject to the family-wise error rate (FWER) correction for multiple comparisons. Results: In HC volunteers, the along-track analysis failed to identify statistically significant differences in the mean FA of DTI streamline bundles. In the mTBI group, significant differences in the mean FA of peri-lesional streamline bundles were found in 21 out of 26 volunteers. In those volunteers where significant differences had been found, these differences were associated with an average of ~47% of all identified CMBs (σ = 21%). In 12 out of the 21 volunteers exhibiting significant FA changes, cognitive functions (memory acquisition and retrieval, top-down control of attention, planning, judgment, cognitive aspects of decision-making) were found to have deteriorated over the six months following injury (r = -0.32, p < 0.001). Our preliminary results suggest that acute post-TBI CMBs may be associated with cognitive decline in some mTBI patients. Future research should attempt to identify mTBI patients at high risk for cognitive sequelae.Keywords: traumatic brain injury, magnetic resonance imaging, diffusion tensor imaging, connectomics
Procedia PDF Downloads 171