Condet

Thomas Charles Becker, PhD

• Assistant Professor in Medicine
• Member of Sarah W. Stedman Nutrition and Metabolism Center

https://medicine.duke.edu/faculty/thomas-charles-becker-phd

A symmetric expanding path similar to a decoder treatment brown recluse bite revia 50 mg with amex, which allows accurate localisation symptoms esophageal cancer order 50mg revia overnight delivery. This step is done to retain boundary information (spatial information) despite down sampling and max-pooling performed in the encoder stage medicine urinary tract infection buy revia 50mg on line. Instead of up-sampling methods 4 medications list generic 50mg revia otc,in U-net, we concatenate the suitable transformed layer from the decoder path. So we used separate learning process for each label, and decide the right label by max on he predictions. Input data was 2D planse along Z-axis, and output data was segmented planes along Z-axis. Training converged slowly and steady, in the first epochs, improvement was around 0. Given two sets, X and Y, it is defined as: where X and Y are the cardinalities of the two sets. The Sшrensen index equals twice the number of pixels common to both sets divided by the sum of the number of elements in each set. To use Dice score for a multi-class classification, we flatten the prediction and the ground truth, to a 1D binary vector, where each section of the sequence, stands for a different class. To stain single label segmentation, we used simple planes with then 4 pixels of that label. This was chosen due to label distribution, which is 11% of label 1, 54 % of label 2 and 35% of label 3. It decrease very slowly in the first step (3-5), then few decreasing leaps, then steady slow decrease of around 0. Tests on smaller batches, like 32, improves fast, but reach plateau very fast as well. The U-net perform well, when segmentation had "blobe" structure, rather then sparse structure. The U-net did not separate well between label 4 and 1, and had bad performance on sparse pixel segmentation. To improve the model, we suggest to explore three main paths: Preprocessing the data and resampling techniques, the other is optional loss functions, and data augmentation. Improvement of the non-sufficient segmentation results on non-enhancing tumor (label ­ 3), is needed. The U-net was not sensitive enough, different architectures, that encodes to smaller size can improve the sensitivity of the segmentation. U-net performs well on large blobs of labeled pixels, but performance decrease when the classified pixels create small sparse areas. Combining different technique, as local pixel segmentation, can be refine the results. Specialized U-net should be built and trained to improve Segmentation results on small tumors. Choice of loss function and resampling techniques, influence learning significantly. Semantic image segmentation with deep convolutional nets and fully connected crfs. Brain tumor segmentation is a challenging task necessary for quantitative tumor analysis and diagnosis. We go on to extract intensity and shape features from the images and cross-validate machine learning models to predict overall survival. Keywords: Glioblastoma · Segmentation · Neural Network · Quantitative Imaging 1 Introduction Gliomas are highly malignant primary brain tumors that carry a dismal median overall survival of 15 months for high grade tumors [1]. One characteristic that contributes to this poor survival is the substantial heterogeneity and differences between distinct glioma subvolumes. Successful and automated detection of these subvolumes is a key step in quantitative analysis towards patient risk stratification and computer aided diagnosis. We go on to extract shape and intensity features from the sub-volumes to predict patient overall survival. The imaging data is brain extracted, registered, and resampled to 1 mm isotropic voxel size. Each subject has a ground truth segmentation with four labels, nontumor (label 0), necrotic and non-enhancing tumor core (label 1), peritumoral edema (label 2), and Gadolinium-enhancing tumor (label 4). The same preproccesing steps were also applied to the validation data set before segmenting.

So treatment tracker order revia 50 mg online, from the beginning we are focusing not merely getting to scale treatment glaucoma buy revia 50 mg lowest price, but on what it is going to take to ensure a functional and effective program (with demonstrated impact) on a continuing basis once we are at scale symptoms 5 weeks 3 days generic 50mg revia with amex. Box 1 contains a set of detailed issues that relate to both the key questions for this chapter medicine 93 5298 50 mg revia free shipping, as well as to other chapters in this guide. In this chapter, we focus on the core questions related to scaling up specifically. What requirements and demands would this make on existing managers or clinical staff? What possible unintended negative (or positive) effects can this have elsewhere in the system? What would the costs be, both in terms of rolling out the new service and in recurrent costs? What systems, including monitoring and evaluation (M&E) systems, need to be in place to ensure quality of service provision for effective performance at scale? Should high need areas be prioritized rather than trying to achieve uniform coverage? The questions outlined here bring us back to many of the issues addressed in Chapter 3 on planning. Durable impact at scale High effective coverage Appropriate service delivery model(s) effectively implemented at scale Realistic testing/refining of service delivery approach(es) Policy, systems, and operational conditions are met, including: - Supplies of drugs and commodities - Personnel (service providers, managers, and so forth) equipped and supported for their roles with appropriate training, and tools - Supervision and monitoring systems in place and functioning What conditions need to be satisfied to achieve this vision? Specify who will be responsible for developing: Roles/responsibilities Work plans/budgets Coordination/planning/oversight Specify who will be responsible for developing: Roles/responsibilities Work plans/budgets Coordination/planning/oversight Developing a Scale-Up Plan A good plan is always a work-in-progress and will need to be adapted as scale-up progresses. Looking beyond just the first steps of planning for scale-up to how to ensure continued institutionalized high performance at scale is the long-term goal. Doing so requires foresight and making appropriate choices now to ensure that we create the conditions for success later. A "learning phase"1 (or piloting) is a realistic, reasonably large-scale practice run, which is rigorously monitored to generate learning on key operational issues. On the basis of the learning from this phase, the approach may be adapted to try to ensure better performance in the next stage of scaling up. The best plans are those that have been adjusted in response to feedback as plan implementation proceeds. Elements that need to be considered in planning (from which specific anticipated strategic tasks can be derived) include the following: · · Supplies of drugs and commodities Personnel. This is best carried through processes that include monitoring of key indicators of the program, including quality of care. Gain and Maintain Support from Policy-Makers at the Relevant Levels Key gate-keepers and opinion leaders. Potential champions, who are well-placed to influence opinion and decisionmaking, need to be identified and encouraged. Policy and regulatory processes, both formal and informal, must be dealt with from the beginning. Examples of formal processes include registration with drug regulatory bodies and revisions to the Essential Medicines List, if the program will introduce any new medications. Informal processes include fully informing and eliciting concerns from key government and nongovernmental counterparts, opinion leaders, and funding agencies. Sustain Program Momentum Program momentum may diminish for a range of reasons including withdrawal of support from a key stakeholder, budgetary constraints, poor management and supervision, and so forth. An alternative is to assign this responsibility to an existing technical working group, if it has a suitable membership and mandate. An example might be a Ministryled working group responsible for community health services. Sustaining program momentum involves ensuring effective and sustained functioning of whatever group is selected, including that regular meetings are held, action points are identified, and follow-up is carried out. In developing any new approach, strategy, or product, one has to start with where the user is now, "bridging from the known to the new. Then, messaging and strategies related to scaling-up can be geared to this current reality.

If in doubt symptoms with twins discount 50 mg revia free shipping, an opinion should be sought from the clinician or pathologist to determine how the case can most accurately be entered in the registry medicine xarelto cheap revia 50 mg mastercard. No topography (site) is to be considered in determining multiple primaries of lymphatic and hematopoietic discases treatment 10 discount revia 50mg line. Multiple primaries are determined by histology (see the tables at the back of this manual) medicine daughter generic 50 mg revia with visa. Answer: Q28 You might have said lymphomas are primarily of lymph node origin, but two common extralymphatic sites are the stomach and small intestine or any of the extralymphatic sites listed on page 94. Actually, the heart is a double pump, driving the blood through two circuits (Figures 14A-D): · the pulmonary circuit conveys blood from the right side of the heart to the lungs and then returns it to the left side of the heart (see page 105). The systemic circuit carries blood from the left side of the heart to the rest of the body and returns it to the right side of the heart (see page 105). In addition to its primary function of transporting various substances to and from body cells, the circulatory system contributes to cellular metabolism, balance (homeostasis) of fluid volume, balance of Ph (hydrogen-ion concentration), homeostasis of body temperature, and defense against microorganisms. The circuit conveys blood to the lungs and then returns it to the side of the heart. The the Q3 the primary function of the cardiovascular system is to cells thus providing them with and blood to and from the body and carrying away circuit conveys blood to the rest of the body and then returns it to side of the heart. Answer: Q2 1) the pulmonary circuit conveys blood to the lungs and then returns it to the left side of the heart. Answer: Q3 the primary function of the cardiovascular system is to transport (carry) blood to and from the body cells thus providing them with food (nutrients) and oxygen, and carrying away waste products. Answer: Q4 the cardiovascular system also contributes to: 1) Cellular metabolism "Metabolism" is usually the term applied to the over-all series of chemical reactions taking place within the body cells in which oxygen and nutrients are consumed and carbon dioxide and other wastes are produced in the release of energy. The right atrium, which receives blood from the systemic circulation, is larger than the left atrium, which receives blood from the lungs only. Both atria have thinner walls than do the ventricles since they have less pressure exerted on them than do the ventricles, just as veins have thinner walls than do arteries. The walls of the left ventricle are thicker because the left ventricle must pump blood to the most distant parts of the body; the right ventricle pumps blood only to the lungs. The openings between the atria and ventricles, the atrioventricular cuspid valves: · · orifices, are controlled by the tricuspid valve controls the opening between the right atrium and the right ventricle. The mitral (bicuspid) valve controls the opening between the left atrium and the left ventricle. Semilunar valves control the opening from the right ventricle into the pulmonary artery and the opening from the left ventricle into the great aorta. The heart muscle (myocardium) receives its blood supply from the branches of the right and left coronary arteries (Figure 14B). These vessels come off the ascending aorta just as this structure exits from the left ventricle. A small mass of modified cardiac muscle called the sinoatrial node and an additional mass now termed the atrioventricular junction, along with an abundant nerve supply, contribute to the stimulation and regulation of heart action. The inner portion consists of two layers: · · the parietal layer lining the inside of the fibrous pericardium the visceral layer (epicardium) adhering to the exterior surface of the heart. Between the parietal and visceral layers is a potential space, the pericardial space, which contains a few drops of pericardial fluid. The walls of the heart are composed of three layers: · the epicardium or outer layer of the heart (the visceral layer of the serous pericardium described above) ° the myocardium or heart muscle · the endocardium or inner lining of the four chambers of the heart. From the right atrium, the blood moves through the tricuspid valve into the right ventricle. When the right ventricle contracts, the tricuspid valve closes and the blood is forced through the pulmonary semilunar valve into the pulmonary trunk which divides into the right and left pulmonary arteries. The blood flows through the pulmonary arteries to the pulmonary capillaries where it absorbs oxygen and releases carbon dioxide. From the left atrium, the blood moves through the mitral (bicuspid) valve into the left ventricle.

In majority of the cases it occurs during pregnancy due to the environment in the womb or defects in development of the fetus symptoms mononucleosis cheap revia 50 mg on line. Dyskinetic: (Dystonic 6 mp treatment order 50mg revia amex, athetoid) Cerebral Palsy: Involuntary movements in different parts of the body treatment breast cancer safe 50mg revia, make it difficult for the patient to carry out intentional activities symptoms 5dpo revia 50mg generic. Ataxic Cerebral Palsy and Hypotonic Cerebral Palsy: the patient finds it difficult to maintain balance. Besides, following features may co-exist (A) Squint in 50%-60% children (B) Visual problem including field defect (C) Epilepsy - 66% 4. Stubbornness, hyperactivity General Information: Cerebral Palsy may not necessarily be harmful for every child and it is not that improvement is not possible. In other cases extensive exercise (physiotherapy), along with appropriate drugs may offer little results after a along period of treatment. In the first month after the birth the child may appear normal but gradually it is seen that the development is very slow, becomes slow or the child is never able to learn to sit by himself. A normal child learns to walk in the first year, which is delayed due to this disease, and even if the child learns to walk he tries to stand on his toes and walking is very difficult. Similarly, development of the brain and intelligence is low in most of these children. In addition to that they learn to speak very late and the pronunciations are not clear. Diagnosis: Cerebral Palsy can generally be diagnosed through physical examination of a child itself. One has to accept the reality and start special training from the day of diagnosis. The training given to small children below age of 5 years, is called early intervention. Considering the exact damage to the child, combination therapy of following different therapists is advocated. Thus the aim of this training and treatment is - Independence in the, daily living/activities - Social acceptance- Educational achievement - Economical independence i. In spite of so much advancesment in the field of medical science such cases can neither be prevented nor treated properly. Thus it is our social, moral and humane duty to financially support physiotherapy centers and institutions treating and training these children. One must also think of starting such new institutions or spare some time for development of these children and give warmth and support. Prevention: Most important is to help create public awareness regarding care of a pregnant woman, need for regular antenatal checking with a gynecologist, importance of. Encased safely within the veraebrae of the vertebral column the spinal cord is a very important organ of the nervous system. There are over 30 types of diseases that can occur in the spinal cord which can be understood in terms of the working and the structure of the spinal cord, its function of carrying the messages, its length, its cylindrical shape, its small width, its membranes, its blood vessels, its relation with the vertebrae etc. Symptoms of the diseases of the spinal cord: l Weakness or paralysis of the lower limbs. The symptoms of spinal cord diseases are mainly seen as a syndrome and are very obvious, hence the diagnosis is usually clear. If there is damage in the part of the spinal cord situated between the cervical vereabrae, it is known as cervical myelopathy in which the normal movements as well as the sensations of the legs and hands get hampered. The spinal cord is usually not found in the lumbar vertebrae, that is, the spinal cord ends at the first lumbar L1 vertebra. From here it gets transformed into the nerves known as Cauda Equina (like the tail of a horse). In the diseases affecting only the spinal cord, there are no symptoms related to the brain like speech defects, ability to understand, sensations of eyes, ears, nose, seizures, one sided paralysis or facial paralysis, etc. If the above-mentioned symptoms are present, the disease is of some other origin and not purely of spinal cord. All the sensation in the spinal cord being cut off below a certain level, with loss of movements of both legs, retention of stool and urine may occur. The working of certain sensory nerves gets disturbed and its motor functioning decreases along with pain in the nerve.

As mentioned earlier symptoms pink eye revia 50 mg with mastercard, encephalomyelitis may also occur following vaccination for rabies symptoms 20 weeks pregnant cheap 50 mg revia free shipping, small-pox etc symptoms 7 days after ovulation discount 50 mg revia overnight delivery. Approximately one in 750 people receiving antirabies vaccine is likely to develop this illness and the mortality rate can be as high as 25% symptoms 0f parkinson disease order revia 50mg. Even after numerous researches no accurate or effective treatment is yet available and the patient becomes weaker and thinner day-by-day and the doctor and relatives, helplessly watch him getting closer towards certain death. Unfortunately, the brain keeps on relatively functioning normal, till the end, so thoughts, emotions, consciousness, pain etc can still be felt. First of all, let us discuss about the primary (idiopathic) motor neuron disease, which occurs due to unknown reasons. In this, the main defect is in the motor neurons, and so the anterior horn cells from which the nerves of the spinal cord originate, and the brain stem or the bulbar neurons from which the cranial nerves emerge, are gradually destroyed due to some unknown reasons. There is difficulty in holding things, writing or moving the hands up and down and gradually climbing stairs and even wearing footwear also becomes difficult. In 3 to 7 years of the onset of the disease the patient becomes completely bedridden and the body weight reduces drastically. In this, the anterior horn cells of the spinal cord as well as the pyramidal fibres, which control the spinal cord, are affected. Progressive Muscular Atrophy is a type of motor neuron disease in which the pyramidal fibres are not affected and thus the neurological signs of upper motor neuron are not seen (like brisk jerk, extensor plantar etc). As mentioned earlier, in Bulbar Motor Neuron disease, the cells from which the cranial nerves emerge get afflicted and so important functions like swallowing food, and speech etc get affected and there is difficulty in respiration. In some cases by chance the disease is limited to a single limb, which is known as Monomelic Motor Neuron Disease. Associated deafness, which is not present in other motor neuron diseases, is noted in Madras Motor Neuron disease. It is essential to get a confirmed diagnosis of this disease by a Neurologist, as the patient has very less active functional lifetime left after being afflicted by this disorder. The patient and the relatives should be timely informed about the seriousness of the disease, so that the patient can make arrangements for the rest of his life. Muscles can be kept functional, as far as possible by physiotherapy, muscle training, walking exercise etc. Along with that the patient should make use of instruments like crutches and calipers, to ease the functions like walking and moving hands. After a lot of research, a recently discovered drug called Riluzole (Rilutec) is being used. Usually it is given for 3 months and the expenses come to about 60 to 70 thousand Indian Rupees. But the disease can be slowed down only for about 3 to 6 months, which only prolongs the torture. The general experience is that it has no magical role in the treatment, although it can be used in appropriate cases. If swallowing of food, speech etc gets affected; proper training can help to a certain extent. Necessary medical treatment should be given in case of emotional lability, depression, involuntary laughing and crying etc. Eventually the life span of the patient can be prolonged a little, by helping in respiration with the ventilator machine. There is an association of patients of this disease called "Motor Neuron Disease Association" which provides relevant information to the patients. The nerves that carry messages to the muscles are known as motor nerves and the nerves that carry sensations from end organs towards brain are called sensory nerves. Whereas the diseases of the nerves mentioned earlier are known as peripheral neuropathy. There are many types of peripheral neuropathies and the main ones are polyneuropathy, entrapment neuropathy, mononeuropathy, mononeuropathy multiplex etc. There are other cases in which the neuropathy is secondary to other neurological disease or disease of any other system. In mononeuropathy there is damage in the working of one or more different types of nerves, which ache together. In entrapment neuropathy one or more nerves are compressed somewhere in their routine pathway. In polyneuropathy, usually sensations decrease equally on both sides of the body, muscle power decreases and other problems like bowel and bladder problems also arise.

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