Search

Purpose Allogeneic stem cell transplantation would benefit from re-engineering care towards an integrated eHealth-facilitated care model. With this paper we aim to: (1) describe the development of an integrated care model (ICM) in allogeneic SteM-cell-transplantatIon faciLitated by eHealth (SMILe) by combining implementation, behavioral, and computer science methods (e.g., contextual analysis, Behavior Change Wheel, and user-centered design combined with agile software development); and (2) describe that model’s characteristics and its application in clinical practice. Methods The SMILe intervention’s development consisted of four steps, with implementation science methods informing each: (1) planning its set-up within a theoretical foundation; (2) using behavioral science methods to develop the content; (3) choosing and developing its delivery method (human/technology) using behavioral and computer science methods; and (4) describing its characteristics and application in clinical practice. Results The SMILe intervention is embedded within the eHealth enhanced Chronic Care Model, entailing four self-management intervention modules, targeting monitoring and follow-up of important medical and symptom-related parameters, infection prevention, medication adherence, and physical activity. Interventions are delivered partly face-to-face by a care coordinator embedded within the transplant team, and partly via the SMILeApp that connects patients to the transplant team, who can monitor and rapidly respond to any relevant changes within 1 year post-transplant. Conclusion This paper provides stepwise guidance on how implementation, behavioral, and computer science methods can be used to develop interventions aiming to improve care for stem cell transplant patients in real-world clinical settings. This new care model is currently being tested in a hybrid I effectiveness-implementation trial.

Pregnant sheep have been used to model complications of human pregnancies including placental insufficiency and intrauterine growth restriction. Some of the hallmarks of placental insufficiency are slower uterine and umbilical blood flow rates, impaired placental transport of oxygen and amino acids, and lower fetal arterial concentrations of anabolic growth factors. An impact of fetal sex on these outcomes has not been identified in either human or sheep pregnancies. This is likely because most studies measuring these outcomes have used small numbers of subjects or animals. We undertook a secondary analysis of previously published data generated by our laboratory in late-gestation (gestational age of 133 ± 0 days gestational age) control sheep (n = 29 male fetuses; n = 26 female fetuses; n = 3 sex not recorded) and sheep exposed to elevated ambient temperatures to cause experimental placental insufficiency (n = 23 male fetuses; n = 17 female fetuses; n = 1 sex not recorded). The primary goal was to determine how fetal sex modifies the effect of the experimental insult on outcomes related to placental blood flow, amino acid and oxygen transport, and fetal hormones. Of the 112 outcomes measured, we only found an interaction between fetal sex and experimental insult for the uterine uptake rates of isoleucine, phenylalanine, and arginine. Additionally, most outcomes measured did not show a difference based on fetal sex when adjusting for the impact of placental insufficiency. Exceptions included fetal norepinephrine and cortisol concentrations, which were higher in female compared to male fetuses. For the parameters measured in the current analysis, the impact of fetal sex was not widespread.

BackgroundWilson disease (WD) is a rare disease wherein copper accumulates in tissues, leading to hepatic degeneration, neurological impairments, and psychiatric symptoms. This study aimed to characterize the patient experience of WD and develop a conceptual model containing key symptoms and impacts of the disease.ResultsA targeted literature review was conducted to develop a preliminary conceptual model of WD that was subsequently refined through one-on-one interviews with 3 WD clinicians and finalized following concept elicitation interviews with 11 patients and 1 caregiver. The literature review returned 30 articles, from which 45 concepts (35 signs/symptoms and 10 impacts) were selected for inclusion in the preliminary conceptual model. After interviews with clinicians, the model was expanded to include 45 signs/symptoms and 14 impacts. The final comprehensive conceptual model developed after interviews with patients included 54 symptoms in total (n = 22 hepatic, n = 19 neurological, n = 13 psychiatric), and 21 impacts. Across symptoms, patients reported a high level of bother, with approximately 49% of symptoms reported by patients having an average peak bother rating of ≥ 7 out of 10 (10 = most bothersome). Patient interviews identified 2 subgroups of patients: those who experience neurological, psychiatric, and hepatic symptoms and those who experience mostly hepatic and some psychiatric symptoms, but no neurological symptoms.ConclusionsThis research underscores the substantial multisystemic symptoms and impacts that patients with WD describe as highly bothersome in their lives. Hepatic symptoms emerged as especially common and important to patients with WD, possibly beyond what is commonly understood in research and clinical practice. Further, the description of 2 distinct patient groups may help to inform patient management and support more targeted drug development processes.

Background Spinal muscular atrophy (SMA) is a rare, genetic, progressive neuromuscular disorder characterized by severe muscle atrophy and weakness and is a leading genetic cause of death in infants and children. Nusinersen was the first treatment targeting the underlying cause of disease approved by the FDA, EMA and other countries for patients with SMA. There are currently very limited data available on the health-related quality of life (HRQoL) burden of SMA suitable for use in a cost-effectiveness analysis. Objective This study was designed to estimate quality of life weights or utilities for different SMA states. Methods SMA case studies were developed describing Type I (infantile onset) and Type II (later-onset) patients and different outcomes from treatment. These were developed so that quality of life weights or utilities (where the value of health ranges from 1 - full health to 0 - dead) could be estimated for cost-effectiveness analysis. Clinical experts (n=5) rated each of the case studies using standardized HRQoL instruments - the EQ-5D-Y and PedsQL-NMM (baseline states only). Results The SMA Type I utilities ranged from -0.33 (requires ventilation) to 0.71 (Type I patient reclassified as Type III following treatment), with quite substantial differences between some states. Most Type I states had a utility score below zero indicating the severity of the states. The SMA Type II utilities ranged from -0.13 (worsened) to 0.72 (stands/walks unaided). In general, the results showed HRQoL improved in line with better health states. Conclusion The utility scores obtained in this study highlight the very substantial burden experienced by SMA patients. Despite the limitations in the methods used, this study produced data with face validity and is a useful starting point for understanding the burden of SMA Types I and II in cost-effectiveness analysis.

PURPOSE: To describe a process of creating eHealth components for an integrated care model using an agile software development approach, user-centered design and, via the Behavior Change Wheel, behavior theory-guided content development. Following the principles of implementation science and using the SMILe project (integrated care model for allogeneic stem cell transplantation facilitated by eHealth) as an example, this study demonstrates how to narrow the research-to-practice gap often encountered in eHealth projects. METHODS: We followed a four-step process: (a) formation of an interdisciplinary team; (b) a contextual analysis to drive the development process via behavioral theory; (c) transfer of content to software following agile software development principles; and (d) frequent stakeholder and end user involvement following user-centered design principles. FINDINGS: Our newly developed comprehensive development approach allowed us to create a running eHealth component and embed it in an integrated care model. An interdisciplinary team's collaboration at specified interaction points supported clear, timely communication and interactions between the specialists. Because behavioral theory drove the content development process, we formulated user stories to define the software features, which were prioritized and iteratively developed using agile software development principles. A prototype intervention module has now been developed and received high ratings on the System Usability Scale after two rounds of usability testing. CONCLUSIONS: Following an agile software development process, structured collaboration between nursing scientists and software specialists allowed our interdisciplinary team to develop meaningful, theory-based eHealth components adapted to context-specific needs. CLINICAL RELEVANCE: The creation of high-quality, accurately fitting eHealth components specifically to be embedded in integrated care models should increase the chances of uptake, adoption, and sustainable implementation in clinical practice. ispartof: JOURNAL OF NURSING SCHOLARSHIP vol:53 issue:1 pages:35-45 ispartof: location:United States status: published

Objectives\ud \ud This study sought to identify the clinical and biochemical characteristics that would help distinguish hypophosphatasia (HPP) from other metabolic bone diseases in adult patients attending a metabolic bone clinic by comparing patients who have genetically confirmed HPP with a group of patients with low bone mineral density (BMD) in the osteoporotic or osteopenic range.\ud \ud \ud Methods\ud \ud Data were collected from February 2016 to October 2018 for 41 patients (n = 20 in the HPP group, n = 21 in the low-BMD group) attending the metabolic bone clinic at Sheffield, United Kingdom (UK) or who were recruited via the Rare UK Diseases Study (RUDY) platform during the same period. A study questionnaire was administered to all patients, and assessments were conducted for laboratory values, physical functions, BMD, and spine imaging.\ud \ud \ud Results\ud \ud Patients with HPP were characterized as being younger, more likely to have metatarsal or femoral shaft fractures, and less likely to have vertebral fractures compared with patients in the low-BMD group. The HPP group had lower total and bone-specific alkaline phosphatase, higher pyridoxal 5′-phosphate (PLP), and lower, albeit sufficient, 25-hydroxyvitamin D. Low-BMD group had lower C-terminal telopeptide and tartrate-resistant acid phosphatase 5b (61.9% were on bisphosphonates at enrollment). Dual X-ray absorptiometry (DXA) analysis found that the HPP group had higher total hip and lumbar BMD T- and Z-scores compared with the low-BMD group. There were no differences found between the two groups with physical functional assessments. Results of receiver operating characteristic analysis indicated strong diagnostic accuracy of these biomarkers for HPP. Thresholds of total alkaline phosphatase (ALP) activity of 43 IU/L or less and PLP level of 120 nmol/L or more were determined to be potentially clinically useful for distinguishing HPP from other metabolic bone diseases.\ud \ud \ud Conclusion\ud \ud This study supported the use of ALP and PLP measurements as predictive of HPP diagnosis along with certain demographic and clinical characteristics (younger age, metatarsal or femoral fractures without low mean BMD T- and Z-scores on a DXA scan) that can aid in recognizing adults who should be further evaluated for HPP. The critical values identified need to be applied to an independent sample to be tested for diagnostic accuracy.

PURPOSE: We report on our contextual analysis's methodology, as a first step of an implementation science project aiming to develop, implement, and test the effectiveness of an integrated model of care in SteM-cell transplantatIon faciLitated by eHealth (SMILe). METHODS: We applied an explanatory sequential mixed-methods design including clinicians and patients of the University Hospital Freiburg, Germany. Data were collected from 3/2017 to 1/2018 via surveys in 5 clinicians and 60 adult allogeneic stem-cell transplantation patients. Subsequently, we conducted 3 clinician focus groups and 10 patient interviews. Data analysis followed a 3-step process: (1) creating narrative descriptions, tables, and maps; (2) mapping key observational findings per dimension of the eHealth-enhanced Chronic-Care Model; (3) reflecting on how findings affect our choice of implementation strategies. RESULTS: Current clinical practice is mostly acute care driven, with no interdisciplinarity and weak chronic illness management. Gaps were apparent in the dimensions of self-management support and delivery-system design. Health behaviors that would profit from support include medication adherence, physical activity and infection prevention. The theme "being alone and becoming an expert" underpinned patients need to increase support in hospital-to-home transitions. Patients reported insecurity about recognizing, judging and acting upon symptoms. The theme "eHealth as connection not replacement" underscores the importance of eHealth augmenting, not supplanting human contact. Synthesis of our key observational findings informed eight implementation strategies. CONCLUSION: Stakeholders are willing towards a chronic care-focused approach and open for eHealth support. The contextual information provides a basis for the SMILe model's development and implementation. ispartof: EUROPEAN JOURNAL OF ONCOLOGY NURSING vol:45 ispartof: location:Scotland status: published

Background Disease activity of patients with ulcerative colitis (UC) predicts health-related quality of life (HRQL) and work-related outcomes (eg, absenteeism, productivity). We tested whether outcomes differed among patients in complete (clinical and endoscopic) remission, partial remission, or not in remission following treatment with multimatrix mesalamine. Methods Data were from an open-label, multicountry, prospective trial (ClinicalTrials.gov identifier: NCT01124149) of 717 adults with active mild-to-moderate UC treated with 4.8 g/day multimatrix mesalamine tablets for 8 weeks (induction period); 459 patients who achieved partial or complete remission received daily 2.4 g/day multimatrix mesalamine for 12 additional months (maintenance period). HRQL (SF-12v2 Health Survey and Short Inflammatory Bowel Disease Questionnaire) and work-related outcomes (Work Productivity and Activity Impairment questionnaire) were assessed at baseline and final visits of each treatment period. Differences in scores by remission status within each treatment period were tested using analysis of variance and analysis of covariance models, whereas mixed-effects models with repeated measures tested changes over time. Results At their final visit of each treatment period, patients in partial remission scored significantly better on all HRQL and work-related domains than patients not in remission (all Bonferroni-adjusted P < 0.05). Scores for patients in partial remission were, almost without exception, statistically equivalent to those for patients in complete remission. Fluctuating between complete and partial remission during maintenance treatment had no impact on outcomes. Conclusions Patients in partial remission following multimatrix mesalamine treatment had HRQL and work-related outcomes equivalent to patients in complete remission. Achievement and maintenance of partial remission may be sufficient for improvements in patients’ functioning, well-being, and work performance.

The AMCP Managed CareSpecialty Pharmacy Annual Meeting 2019 in San Diego, California, is expected to attract more than 4,000 managed care pharmacists and other health care professionals who manage and evaluate drug therapies, develop and manage networks, and work with medical managers and information specialists to improve the care of all individuals enrolled in managed care programs. The AMCP Abstracts program provides a forum through which authors can share their insights and outcomes of advanced managed care practice. Poster presentations are scheduled for Wednesday, March 27, from 11:30 am to 1:00 pm. Posters will also be displayed on Tuesday, March 26, from 5:30 pm to 7:00 pm, during the opening night reception in the Expo, and on Thursday, March 28, from 9:30 am to 11:00 am. Podium presentations for the Platinum award-winning abstracts are Tuesday, March 26, from 2:30 pm to 3:45 pm. Professional abstracts that have been reviewed are published in the Journal of Managed CareSpecialty Pharmacy's Meeting Abstracts supplement. Abstracts were submitted in the following categories.

Spinal muscular atrophy is a rare neuromuscular disorder with a spectrum of severity related to age at onset and the number of SMN2 gene copies. Infantile-onset (≤ 6 months of age) is the most severe spinal muscular atrophy and is the leading monogenetic cause of infant mortality; patients with later-onset (> 6 months of age) spinal muscular atrophy can survive into adulthood. Nusinersen is a new treatment for spinal muscular atrophy. The objective of this study was to evaluate the cost effectiveness of nusinersen for the treatment of patients with infantile-onset spinal muscular atrophy and later-onset spinal muscular atrophy in Sweden. One Markov cohort health-state transition model was developed for each population. The infantile-onset and later-onset models were based on the efficacy results from the ENDEAR phase III trial and the CHERISH phase III trial, respectively. The cost effectiveness of nusinersen in both models was compared with standard of care in Sweden. For a time horizon of 40 years in the infantile-onset model and 80 years in the later-onset model, treatment with nusinersen resulted in 3.86 and 9.54 patient incremental quality-adjusted life-years and 0.02 and 2.39 caregiver incremental quality-adjusted life-years and an incremental cost of 21.9 and 38.0 million SEK (Swedish krona), respectively. These results translated into incremental cost-effectiveness ratios (including caregiver quality-adjusted life-years) of 5.64 million SEK (€551,300) and 3.19 million SEK (€311,800) per quality-adjusted life-year gained in the infantile-onset model and later-onset model, respectively. Treatment with nusinersen resulted in overall survival and quality-adjusted life-year benefits but with incremental costs above 21 million SEK (€2 million) [mainly associated with maintenance treatment with nusinersen over a patient’s lifespan]. Nusinersen was not cost effective when using a willingness-to-pay threshold of 2 million SEK (€195,600), which has been considered in a recent discussion by the Dental and Pharmaceutical Benefits Agency as a reasonable threshold for rare disease. Nonetheless, nusinersen gained reimbursement in Sweden in 2017 for paediatric patients (below 18 years old) with spinal muscular atrophy type I–IIIa.

We report the design and operation of a surface-emitting surface acoustic wave (SAW) acousto-optical modulator which behaves as a cm-scale linear hologram in response to an applied electronic waveform. The modulator is formed by an optical waveguide, transducer, and out-coupling surface grating on a 1 mm-thick lithium niobate substrate. We demonstrate the ability to load and illuminate a 9-region linear hologram into the modulator's 8 mm-long interaction region using applied waveforms of 280-320 MHz. To the best of the authors' knowledge, this is the first demonstration of a monolithically-integrated, surface-emitting SAW modulator fabricated using lithographic techniques. Applications include practical implementations of a holographic display., Comment: 6 pages plus 1 page of long-form references; 6 figures

Objective Carotid intima media thickness (CIMT) and local stiffness are vascular biomarkers of atherosclerotic burden. We investigated the variability and reproducibility of clinically relevant structural (CIMT, lumen diameter) and functional parameters (strain, distensibility, compliance, β-stiffness index, Peterson's elastic modulus and Young's elastic modulus) measured in B-mode ultrasound sequences of the common carotid artery in the second follow up of the S wiss Cohort Study on A ir P ollution a nd L ung and Heart D iseases I n A dults (SAPALDIA3). Methods Ultrasound sequential images were examined twice over a 1 cm segment across at least one heart cycle in 165 SAPALDIA3 participants. To assess variability and reproducibility of structural and functional parameters, individual coefficients of variation (CV), intraclass correlation (ICC), Bland–Altman plots and mixed effect regressions were used. Results ICCs of repeated examinations ranged between 0.67 and 0.77 for blood pressure indices, between 0.87 and 0.97 for structural properties and between 0.75 and 0.79 for functional parameters. CV was lowest in structural parameters (1.6–4.6%), followed by blood pressure (5.1–7.9%) and functional indices (11.0–13.1%). Variations in all parameters were predominantly explained by subjects (>74% in functional, >82% in structural properties). Bland–Altman plots for functional indices showed mean and standard deviation of the respective mean value of 4.2(19.6)% for strain, 1.9(24.4)% for distensibility, 2.4(22.2)% for compliance, 3.0(24.4)% for β-stiffness index, 0.9(25.7)% for Peterson's elastic modulus and 1.2(27.9)% for Young's elastic modulus. Conclusion The results show that SAPALDIA3 measurements of transcutaneous ultrasound examinations have an excellent reproducibility of structural parameters and a good reproducibility of functional indices.

Structural parameters of the common carotid artery (CCA) have shown to correlate with the risk of cardiovascular disease, but their precise measurement is challenging. We developed an automatic detection system with manual interaction capabilities that can reliably analyze B-mode ultrasound sequences of the CCA over several heart cycles. We evaluated 3824 frames from 40 sequences in two data qualities. Two readers measured the intima media thickness (IMT) and the lumen diameter at two evaluation times (T1/T2). A Bland-Altman analysis of the average IMT showed a bias ± SD of 0.002 ± 0.010 mm (T1), −0.004 ± 0.008 mm (T2) for completely automatic detections and −0.004 ± 0.010 mm (T1), −0.003 ± 0.010 mm (T2) for clips with manual corrections. The combination of automated analysis and manual intervention provides precise parameters as biomarkers for the atherosclerotic process and makes the system suitable for large scale epidemiological research, diagnostic and clinical practice.

Image annotation and classification are important areas where pattern recognition algorithms can be applied. In this article we report the insights that we have gained during our participation in the ImageCLEF medical annotation task during the years 2006 and 2007. Grayscale radiograph images taken from clinical routine had to be classified into one of the 116 base classes or labeled with attributes which described various properties of the radiograph. We present an algorithm based on local relational features which is robust with respect to illumination changes. It incorporates the geometric constellation of the feature points during the matching process and thus obtains superior performance. Furthermore, a hierarchical classification scheme is presented which reduces the computational complexity of the classifier.

A cadmium sulfide (CdS) passivation process was demonstrated for the first time on InGaAs/InP p-i-n mesa photodetectors. The passivated devices produced lower reverse bias leakage currents in comparison to devices that received only a thermally deposited SiO2 film. The subsequent deposition of SiO2 on the passivated devices produced virtually no change to the aforementioned leakage currents even after undergoing a 3-h, 300°C thermal treatment. In contrast, similar SiO2 capped devices, fabricated without the CdS passivating layer, show a large increase in leakage current when subjected to the same thermal cycle. Leakage current versus mesa diameter measurements suggest these results are due to reduce surface recombination at the exposed mesa sidewall. X-ray photoelectron spectroscopy (XPS) results indicate the S:Cd ratio of these films to be 0.77.

This work describes the development and fabrication of a novel nanofluidic flow-through sensing chip that utilizes a plasmonic resonator to excite fluorescent tags with sub-wavelength resolution. We cover the design of the microfluidic chip and simulation of the plasmonic resonator using Finite Difference Time Domain (FDTD) software. The fabrication methods are presented, with testing procedures and preliminary results. This research is aimed at improving the resolution limits of the Direct Linear Analysis (DLA) technique developed by US Genomics [1]. In DLA, intercalating dyes which tag a specific 8 base-pair sequence are inserted in a DNA sample. This sample is pumped though a nano-fluidic channel, where it is stretched into a linear geometry and interrogated with light which excites the fluorescent tags. The resulting sequence of optical pulses produces a characteristic "fingerprint" of the sample which uniquely identifies any sample of DNA. Plasmonic confinement of light to a 100 nm wide metallic nano-stripe enables resolution of a higher tag density compared to free space optics. Prototype devices have been fabricated and are being tested with fluorophore solutions and tagged DNA. Preliminary results show evanescent coupling to the plasmonic resonator is occurring with 0.1 micron resolution, however light scattering limits the S/N of the detector. Two methods to reduce scattered light are presented: index matching and curved waveguides.

The calculation of local features at points of interest is a vital part of many current image retrieval and object detection systems. The wavelet-based interest point detector by Loupias et al. was especially developed for image retrieval applications. We show how the detector can be extended by a Laplacian scale selection mechanism to provide scale information and compare it to other state of the art detectors. The extended detector is very well suited for visual object class recognition using feature cluster histograms. It discovers a variety of image structures distributed over the entire image, and the number of regions obtained can be adjusted easily. These properties lead to superior performance, which we confirmed by tests on a difficult animal categorization problem.

In this work, we present a novel, fast clustering scheme for codebook generation from local features for object class recognition. It relies on a sequential data analysis and creates compact clusters with low variance. We compare our algorithm to other commonly used algorithms with respect to cluster statistics and classification performance. It turns out that our algorithm is the fastest for codebook generation, without loss in classification performance, when using the right matching scheme. In this context, we propose a well suited matching scheme for assigning data entries to cluster centers based on the sigmoid function.

Content based automatic image classification systems are increasingly finding usage, e.g. in large medical image databases. This paper concentrates on a grayscale radiograph annotation task which was a part of the ImageCLEF 2006. We use local features calculated around interest points, which have recently received excellent results for various image recognition and classification tasks. We propose the use of relational features, which are highly robust to illumination changes, and thus quite suitable for X-Ray images. Results with various feature and classifier settings are reported. A significant improvement in results is seen when the relative positions of the interest points are also taken into account during matching. For the given test set, our best run had a classification error rate of 16.7 %, just 0.5 % higher than the best overall submission, and therewith was ranked second in the medical automatic annotation task at the ImageCLEF 2006. The proposed method is general, can be applied to other image classification tasks and can also be extended to colour images.

We have fabricated polycrystalline diamond hemispheres by hot-filament CVD (HFCVD) in spherical cavities wet-etched into a high temperature glass substrate CTE matched to silicon. Hemispherical resonators 1.4 mm in diameter have a Q of up to 143 000 in the fundamental wineglass mode, for a ringdown time of 2.4 s. Without trimming, resonators have the two degenerate wineglass modes frequency matched as close as 2 Hz, or 0.013% of the resonant frequency (~16 kHz). Laser trimming was used to match resonant modes on hemispheres to 0.3 Hz. Experimental and FEA energy loss studies on cantilevers and hemispheres examine various energy loss mechanisms, showing that surface related losses are dominant. Diamond cantilevers with a Q of 400 000 and a ringdown time of 15.4 s were measured, showing the potential of polycrystalline diamond films for high Q resonators. These resonators show great promise for use as hemispherical resonant gyroscopes (HRGs) on a chip.

Image classification systems have received a recent boost from methods using local features generated over interest points, delivering higher robustness against partial occlusion and cluttered backgrounds. We propose in this paper to use relational features calculated over multiple directions and scales around these interest points. Furthermore, a very important design issue is the choice of similarity measure to compare the bags of local feature vectors generated by each image, for which we propose a novel approach by computing image similarity using cluster co-occurrence matrices of local features. Excellent results are achieved for a widely used medical image classification task, and ideas to generalize to other tasks are discussed

We describe and compare three probabilistic ways to perform Content Based Image Retrieval (CBIR) in compressed domain using images in JPEG2000 format. Our main focus are arbitrary non-uniformly textured color images, as can be found, e.g., in home user image collections. JPEG2000 offers data that can be easily transferred into features for image retrieval. Thus, when converting images to JPEG2000, feature extraction comes at a low cost. For feature creation, wavelet subband data is used. Color and texture features are modelled independently and can be weighted by the user in the retrieval process. For texture features in common databases, we show in which cases modelling wavelet coefficient distributions with Gaussian Mixture Models (GMM) is superior in to approaches with Generalized Gaussian Densities (GGD). Empirical tests with data collected by non-expert users evaluate the usefulness of the ideas presented.

III-V based single photon avalanche diodes (SPADs), avalanche photodiodes (APDs) operated in Geiger-mode, are ideally suited for ultra-weak signal detection in the near infrared for photon counting and photon timing applications. Spaceborne SPADs would provide a rugged, compact alternative to photomultiplier tubes with lower operating voltage requirements, stronger near-IR response, and the possibility for array implementation. Results from a performance characterization of an in-house fabricated In0.53Ga0.47As/InP SPAD are presented. Sensitivity (NEP) and timing resolution (δt) were investigated as a function of bias from T = 135 K to 165 K; an NEP ≈ 5 x 1015W/Hz1/2 at T = 150 K and δt ≈ 230 ps at T = 165 K were measured for λ = 1.55 μm light.

Epitaxial layer transfer was used to fabricate In/sub 0.53/Ga/sub 0.47/As-InP avalanche photodiodes on GaAs substrates. The photodiodes displayed a gain-bandwidth product of 80 GHz, dark current of 10.20 nA at 90% of the breakdown voltage, and responsivity of 5.9 A/W at 2 V below breakdown. Performance is comparable to standard devices fabricated on InP substrates, suggesting the transfer process does not degrade material quality.

In this paper we report the fabrication of hemispherical polycrystalline diamond resonators fabricated on a novel high-temperature glass substrate. The hemispherical resonator gyroscope is one of the most accurate and rugged of the mechanical gyroscopes, and can be operated in either rate or whole-angle mode due to its high degree of symmetry. A fabrication sequence for creating extremely symmetric 3D MEMS hemispheres is presented. Mode shapes and frequencies obtained with a laser vibrometer are shown, as well as curves of Q versus pressure, and the dependence of frequency on anchor size. Fundamental mode frequency matching to

Lipoblastoma is an uncommon benign lipomatous soft tissue mass of childhood, occurring most commonly in children less than 3 years of age. We present a case of lipoblastoma occurring in the foot of a 14-year-old boy and review the literature. The appearance of the mass on magnetic resonance imaging (MRI) is illustrated and is correlated with the findings at gross and microscopic pathological examination. A lobulated architecture, the presence of adipose tissue, thin nonenhancing septa, peripheral lobules of more immature and therefore less specific tissue, and a peripheral pseudocapsule were evident on MRI and at pathological examination.

Many current object class models build on visual parts that constitute an object. However, visually different entities may actually refer to the same object part. This may be harmful for part based object class models. We present a method how visually distinct parts with the same semantic role can be associated by creating groupings based on the similarity of their occurrence distributions. Experimental results verify that more compact class representations can be built based on these groupings, which lead to improved classification performance and/or reduced classification time.

Two hundred one tibial shaft fractures, 160 closed and 41 open (Grades I and II), were treated between January 1978 and June 1982. Sixty patients underwent closed intramedullary Arbeitsgemeinschart Osteosynthesisfragen/Association for the Study of Problems of Internal Fixation (AO/ASIF) nailing with reaming and 141 patients were treated with closed reduction and cast immobilization. Intramedullary nailing resulted in one (1.7%) nonunion, two (3.3%) infections, and no malunions. In the cast treatment group there were 14 (9.9%) delayed or nonunions, two (1.4%) infections, and six (4.3%) malunions. Within this group there were 19 early failures from either inadequate reduction or loss of reduction, which led to a change from nonoperative to operative methods of management. The interval between injury and return to work was 22 weeks in the nailed group, compared with 25.8 weeks in the cast immobilization group.