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Norwegian version of the automatic thoughts questionnaire: a reliability and validity study.

This study investigated the reliability and validity of the Norwegian version of the Automatic Thoughts Questionnaire. Three samples were used: (a) 344 male military recruits; (b) 142 psychiatric outpatients; and (c) 41 healthy controls. The Automatic Thoughts Questionnaire was found to have high internal consistency and satisfactory temporal stability. It correlated positively with the Beck Depression Inventory and was found to discriminate significantly between clinically depressed and non-depressed psychiatric patients and healthy controls. In general the results are satisfactory, suggesting that the Norwegian version of the Automatic Thoughts Questionnaire has adequate reliability and validity properties. The Automatic Thoughts Questionnaire was shown to be a useful measure of frequency of automatic negative thoughts in both clinical and non-clinical populations.

Adult↗

The effect of right and left hemispheric lesions on effortful and automatic memory tasks.

The effect of lateralised cerebral damage on two memory tasks-free recall of words and memory of their temporal order-was investigated under intentional, incidental, and ''true incidental'' learning conditions. Ten Right Brain Damaged patients (RBD), 10 Left Brain Damaged patients (LBD), as well as 15 age-matched and 15 younger control individuals, participated in this study. It was hypothesised that effortful and automatic memory processes involve predominantly the left and right cerebral hemispheres, respectively. Automaticity was defined either by the learning conditions (i.e. incidental-automatic and intentional-effortful) or by the type of task (i.e. temporal-order-automatic and free-recall-effortful) regardless of the learning conditions. In the free recall task the RBD group outperformed the LBD group under all learning conditions. In the temporal order task, the RBD group performed worse than normal controls under all learning conditions while the LBD group performed more poorly than matched controls in the intentional and incidental but not in the ''true incidental'' learning condition. The results are discussed in terms of the relationship between effortful and automatic memory processes and cerebral lateralisation.

Journal Article↗

A method for the automatic reconstruction of fetal cardiac signals from magnetocardiographic recordings.

Fetal magnetocardiography (fMCG) allows monitoring the fetal heart function through algorithms able to retrieve the fetal cardiac signal, but no standardized automatic model has become available so far. In this paper, we describe an automatic method that restores the fetal cardiac trace from fMCG recordings by means of a weighted summation of fetal components separated with independent component analysis (ICA) and identified through dedicated algorithms that analyse the frequency content and temporal structure of each source signal. Multichannel fMCG datasets of 66 healthy and 4 arrhythmic fetuses were used to validate the automatic method with respect to a classical procedure requiring the manual classification of fetal components by an expert investigator. ICA was run with input clusters of different dimensions to simulate various MCG systems. Detection rates, true negative and false positive component categorization, QRS amplitude, standard deviation and signal-to-noise ratio of reconstructed fetal signals, and real and per cent QRS differences between paired fetal traces retrieved automatically and manually were calculated to quantify the performances of the automatic method. Its robustness and reliability, particularly evident with the use of large input clusters, might increase the diagnostic role of fMCG during the prenatal period.

Algorithms↗

Automatic re-contouring in 4D radiotherapy.

Delineating regions of interest (ROIs) on each phase of four-dimensional (4D) computed tomography (CT) images is an essential step for 4D radiotherapy. The requirement of manual phase-by-phase contouring prohibits the routine use of 4D radiotherapy. This paper develops an automatic re-contouring algorithm that combines techniques of deformable registration and surface construction. ROIs are manually contoured slice-by-slice in the reference phase image. A reference surface is constructed based on these reference contours using a triangulated surface construction technique. The deformable registration technique provides the voxel-to-voxel mapping between the reference phase and the test phase. The vertices of the reference surface are displaced in accordance with the deformation map, resulting in a deformed surface. The new contours are reconstructed by cutting the deformed surface slice-by-slice along the transversal, sagittal or coronal direction. Since both the inputs and outputs of our automatic re-contouring algorithm are contours, it is relatively easy to cope with any treatment planning system. We tested our automatic re-contouring algorithm using a deformable phantom and 4D CT images of six lung cancer patients. The proposed algorithm is validated by visual inspections and quantitative comparisons of the automatic re-contours with both the gold standard segmentations and the manual contours. Based on the automatic delineated ROIs, changes of tumour and sensitive structures during respiration are quantitatively analysed. This algorithm could also be used to re-contour daily images for treatment evaluation and adaptive radiotherapy.

Aged↗

Automatic analysis of agarose gel images.

MOTIVATION: Automatic tools to speed up routine biological processes are very much sought after in bio-medical research. Much repetitive work in molecular biology, such as allele calling in genetic analysis, can be made semi-automatic or task specific automatic by using existing techniques from computer science and signal processing. Computerized analysis is reproducible and avoids various forms of human error. Semi-automatic techniques with an interactive check on the results speed up the analysis and reduce the error. RESULTS: We have successfully implemented an image processing software package to automatically analyze agarose gel images of polymorphic DNA markers. We have obtained up to 90% accuracy for the classification of alleles in good quality images and up to 70% accuracy in average quality images. These results are obtained within a few seconds. Even after subsequent interactive checking to increase the accuracy of allele classification to 100%, the overall speed with which the data can be processed is greatly increased, compared to manual allele classification. AVAILABILITY: The IDL source code of the software is available on request from jonathan.flint@well.ox.ac.uk

Animals↗

Model-based automatic feedback control versus human control of end-tidal isoflurane concentration using low-flow anaesthesia.

We studied the clinical use of an automatic feedback control system to adjust the end-tidal anaesthetic concentration with a low-flow method. The end-tidal controller uses two input signals (the end-tidal and inspiratory concentrations) to control the isoflurane concentration in the fresh gas flow, using a model-based algorithm. We studied 22 ASA I-III patients during elective surgery lasting more than 2 h. The anaesthetist was asked to make four step changes of the target end-tidal concentration (+0.3, +0.6, -0.3, -0.6 vol%), either manually (Group A) or by setting the target value for the feedback controller (Group B), and then the control was changed and the step changes were repeated, in a crossover design. Eighty step changes with each control method were compared in terms of response time, maximal overshoot and stability. The automatic control system was more accurate and stable than the human controller for step increases and step decreases, with less overshoot/undershoot and greater stability [e.g. maximal overshoot 14.7 (SD 3.7)% and 18 (8.1)% respectively for +0.6 vol% step changes, and 19.8 (3.7)% and 30.7 (13.2)% respectively for +0.3 vol% step changes]. However, the automatic control system showed a faster response time than the manual method only with large increasing steps (e.g. 149 (32) s and 205 (57) s respectively for +0.6 vol% step changes) and was not different from manual control for decreasing steps. Automatic control of the end-tidal isoflurane concentration can be better than human control in a clinical setting, and this task could be done automatically.

Adolescent↗

Triggered activity and automaticity in ventricular trabeculae of failing human and rabbit hearts.

OBJECTIVE: The aim of the study was to assess the occurrence of triggered activity and automaticity in ventricular trabeculae from failing human hearts and normal and failing rabbit hearts during exposure to a normal and altered extracellular environment. METHODS: Ventricular trabeculae were harvested from failing human hearts (from patients undergoing cardiac transplantation) and from normal and failing rabbit hearts (combined volume and pressure overload). Trabeculae were superfused with normal Tyrode solution followed by a modified Tyrode solution, which mimicked the extracellular milieu in patients with severe heart failure. Modified Tyrode solution contained low potassium (3.0 mM), low magnesium (0.4 mM), and noradrenaline (1 microM). RESULTS: During superfusion with normal Tyrode solution, early afterdepolarisations, delayed afterdepolarisations, and automaticity were not observed in trabeculae from failing hearts. In the modified Tyrode solution, early afterdepolarisations could be induced in 26% of control rabbit and 30% of failing rabbit trabeculae, but never in human trabeculae. During superfusion with the modified solution delayed afterdepolarisations or triggered activity could be induced in 50% of the human failing trabeculae, in 43% of the failing rabbit trabeculae, and in 9% of the normal rabbit trabeculae (p < 0.01); automaticity was observed in 44% of the human trabeculae, and in 7% of the failing rabbit trabeculae, but in none of the control rabbit trabeculae. In failing rabbit myocardium action potential duration was prolonged at cycle lengths > or = 350 ms, but not at shorter cycle lengths. CONCLUSIONS: Delayed afterdepolarisations and automaticity, but not early afterdepolarisations, occur more frequently in myocardium from failing hearts, but only during superfusion with a modified Tyrode solution. This emphasises that the extracellular environment is important with respect to arrhythmogenesis in heart failure, apart from the fixed cellular defect due to heart failure per se. Prolongation of the action potential in failing hearts does not occur at physiological and higher heart rates and therefore cannot be regarded as a protective factor in the prevention of reentrant arrhythmias. The rate of triggered and automatic rhythms was slow. Therefore these mechanisms cannot be responsible for clinical ventricular tachycardias or fibrillation, but may serve as triggers for reentrant arrhythmias.

Animals↗

Reproducibility and automatic measurement of QT dispersion.

This study investigated interobserver (two observers) and intrasubject (two measurements) reproducibility of QT dispersion from abnormal electrocardiograms in patients with previous myocardial infarction, and compared a user-interactive with an automatic measurement system. Standard 12-lead electrocardiograms, recorded at 25 mm.s-1, were randomly chosen from 70 patients following myocardial infarction. These were scanned into a personal computer, and specially designed software skeletonized and joined each image. The images were then available for user-interactive (mouse and computer screen), or automatic measurements using a specially designed algorithm. For all methods reproducibility of the RR interval was excellent (mean absolute errors 3-4 ms, relative errors 0.3-0.5%). Reproducibility of the mean QT interval was good; intrasubject error was 6 ms (relative error 1.4%), interobserver error was 7 ms (1.8%), and observers' vs automatic measurement errors were 10 and 11 ms (2.5, 2.8%). However QTc dispersion measurements had large errors for all methods; intrasubject error was 12 ms (17.3%), interobserver error was 15 ms (22.1%), and observers' vs automatic measurement were errors 30 and 28 ms (35.4, 31.9%). QT dispersion measurements rely on the most difficult to measure QT intervals, resulting in a problem of reproducibility. Any automatic system must not only recognize common T wave morphologies, but also these more difficult T waves, if it is to be useful for measuring QT dispersion. The poor reproducibility of QT dispersion limits its role as a useful clinical tool, particularly as a predictor of events.

Diagnosis, Computer-Assisted↗

Sleep EEG evaluation: a comparison of results obtained by visual scoring and automatic analysis with the Oxford sleep stager.

Oxford Medical has introduced an automatic sleep stager based on the stage-scoring criteria by Rechtschaffen and Kales. With our study we intended to examine whether the results of the stager (version 3.0) match those of the visual evaluation by two independent raters. We also wanted to test the reliability of this automatic sleep stage-scoring system. Ten somnopolygrams of subjects without sleep disturbances served as a basis for the comparison. Each sleep recording was scored twice automatically by the stager, twice visually by the first rater, and once by the second rater. The two automatic analyses of the somnopolygrams differed by 4.3% in a total of 13,850 epochs (1 epoch delta 20 s) regarding sleep stage scoring. The difference between the first and the second visual evaluation by the same rater amounted to 5.7%, whereas the results of the two independent raters deviated by 8.7%. Compared with the results of the visual analysis reached as a consensus by both raters--the so-called optimized visual analysis--the stager showed a 26.9% difference. The automatic analysis scored fewer epochs as stages wake, rapid eye movement (REM), and 2 and more as stages 1, 3, and 4. The sleep stager's frequent difficulty in identifying stage wake correctly as well as its incorrect allocation to other stages--mainly stage REM--could lead to misinterpretations of sleep recordings, whereas the increase in stages 1, 3, and 4, as compared with visual scoring, was negligible.

Adult↗

Automatic tube compensation in patients after cardiac surgery: effects on oxygen consumption and breathing pattern.

OBJECTIVE: To evaluate patients without prior pulmonary disease after cardiac surgery and to determine whether resistive unloading by automatic tube compensation, pressure support ventilation, and continuous positive airway pressure has different effects on oxygen consumption, breathing pattern, gas exchange, and hemodynamics. DESIGN: Prospective, randomized, controlled study. SETTING: Tertiary care, postoperative intensive care unit. PATIENTS: Twenty-one patients scheduled for open heart coronary artery bypass graft surgery. INTERVENTIONS: Each patient was ventilated with all three modes in random order. MEASUREMENTS AND MAIN RESULTS: Patients were ventilated in three modes, each applied for 30 mins according to computer-generated randomization: pressure support ventilation with 5 cm H2O, continuous positive airway pressure, and automatic tube compensation. Oxygen consumption was calculated by means of indirect calorimetry. The hypnotic state of the patients was monitored by Bispectral Index. For hemodynamic measurements, a fiberoptic pulmonary artery catheter was inserted. The main finding of our study was that oxygen consumption and breathing pattern (tidal volume and respiratory rate) did not differ significantly during automatic tube compensation and pressure support ventilation compared with continuous positive airway pressure (oxygen consumption, 170 +/- 29 vs. 170 +/- 26 vs. 174 +/- 29 mL.min.m, respectively; tidal volume, 466 +/- 132 vs. 484 +/- 125 vs. 470 +/- 119 mL, respectively; respiratory rate, 16 +/- 4 vs. 15 +/- 4 vs. 16 +/- 4 breaths/min, respectively). Automatic tube compensation and pressure support ventilation had no clinical effects on gas exchange and hemodynamic variables compared with continuous positive airway pressure. None of the variables differed significantly during the three ventilatory settings. CONCLUSION: In postoperative tracheally intubated patients with normal ventilatory demand, automatic tube compensation and pressure support ventilation with 5 cm H2O lead to identical oxygen consumption, breathing patterns, gas exchange, and hemodynamics. We, therefore, suggest that this group of patients does not need any additional positive pressure support from the ventilator to overcome the additional work of breathing imposed by the endotracheal tube during the weaning phase from mechanical ventilation.

Adult↗

Automatic detection of intradural spaces in MR images.

OBJECTIVE: An algorithm is presented for the automatic detection of intradural spaces in MR images of the human head. The primary motivation behind the present work has been to serve as a preprocessing step in automatic segmentation of brain tissue and CSF. A second objective was to use the algorithm in a fully automatic PET-MR registration algorithm. MATERIALS AND METHODS: The method is primarily designed for, and requires, dual echo (T1- and T2-weighted) MR images with transaxial orientations. The algorithm consists of three main stages. First, the head contour is detected using a series of low-level image-processing techniques. In the second stage, the pixels inside the head contour are clustered into a number of classes using the K-means algorithm. Finally, the extradural connected components are eliminated based on a number of heuristics. RESULTS: Test results are presented for 10 MR image sets consisting of 197 slices. As a quantitative measure of accuracy, manual segmentations were performed by radiologists on a number of slices and compared with the results obtained automatically. CONCLUSION: Visual inspection and quantitative validation of the results indicate that the algorithm accurately detects the intradural spaces in MR images. This is an important step in fully automatic segmentation and registration of MR images.

Algorithms↗

Implementation and validation of a fully automatic system for intra- and interindividual registration of PET brain scans.

PURPOSE: Stereotactic coordinate spaces and methods to adapt subjects to that space are required when performing averaging of functional studies across subjects. METHODS: A rapid and fully automatic method to perform intersubject registration and adaptation to a previously defined coordinate space has been developed and implemented. The implementation has been performed within an existing software developed to facilitate manual registration and adaptation, thus offering a versatile combination of automatic and manual tools. Furthermore, a novel measure, based on the F-statistic for intersubject (block) differences, for the assessment of intersubject goodness of fit was suggested and validated. RESULTS: The intra- and intersubject registration was validated by its application to data from six human subjects participating in an activation study. The registration was performed both manually and automatically, and the results indicated that the automatic method performed at least as well as the manual. The block F-statistic was lower for the automatic method, and the z-scores were not significantly different for the methods. The localization of activated regions showed good agreement and differed by an average of 6 mm between the methods. CONCLUSION: It is concluded that the suggested method is a valuable alternative to the current manual approach.

Adult↗

Comparison of an automatic versus a semiautomatic mode for gray-scale adaptation for digital chest radiography.

PURPOSE: To compare image quality of digital chest radiographs using 2 modes of gradation adjustment. METHODS: We compared image quality and visualization of anatomic landmarks of 50 chest radiographs after digital processing using a semiautomatic mode with a fixed gamma of 2.6 and an automatic mode with individual gamma adaptation. RESULTS: The mean gamma was significantly higher (P < 0.001) with the automatic mode (3.0 vs. 2.6, respectively). Patient constitution had no impact on the automatically adapted gamma for PA but showed a significant correlation (P < 0.001) for lateral images. For PA, there was a preference (P < 0.016) of the semiautomatic mode in heavier patients whereas no difference was seen in slim patients. For the lateral projection, there was a general preference (P = 0.001) of the automatic mode. CONCLUSION: For PA radiographs, the semiautomatic mode provides superior results for heavier patients without compromising the quality in slim patients. For lateral radiographs, the automatic mode provides generally superior results.

Adult↗

Fully automatic luminal contour segmentation in intracoronary ultrasound imaging--a statistical approach.

In this paper, a fully automatic method for luminal contour segmentation in intracoronary ultrasound imaging is introduced. Its principle is based on a contour with a priori properties that evolves according to the statistics of the ultrasound texture brightness, which is generally Rayleigh distributed. The main interest of the technique is its fully automatic character. This is insured by an initial contour that is not set by the user, like in classical snake-based algorithms, but estimated and, thus, adapted to each image. Its estimation combines two pieces of information extracted from the a posteriori probability function of the contour position: the function maximum location (or maximum a posteriori estimator) and the first zero-crossing of its derivative. Then, starting from the initial contour, a region of interest is automatically selected and the process iterated until the contour evolution can be ignored. In vivo coronary images from 15 patients, acquired with the 20-MHz central frequency Jomed Invision ultrasound scanner, were segmented with the developed method. Automatic contours were compared to those manually drawn by two physicians in terms of mean absolute difference. The results demonstrate that the error between automatic contours and the average of manual ones is of small amplitude, and only very slightly higher (0.099 +/- 0.032 mm) than the interexpert error (0.097 +/- 0.027 mm).

Algorithms↗

Metaphase quality can be monitored by automatic counting of bands.

A high quality of cytogenetic preparations is important for maintaining a high standard in the cytogenetic laboratory. In the past, quality has been assessed by visual counting or estimation of the number of bands on chromosomes. In this paper we have counted bands automatically during karyotyping by using the Magiscan chromosome analysis system. A high correlation between automatic and visual counting was found, the automatic counting was reproducible and count figures were comparable when the karyotyping machines were operated by different technicians. The automatic counting procedure has now been included in our routine for 1 year. The highest numbers of bands were counted on slides from peripheral blood, with fewer bands for amniotic fluid and the lowest number for cells from chorionic villi. All three cell types showed significant variations in band number over time, which may be due to changes in weather conditions and/or the reagents used for cell culture, harvest and staining. It is concluded that the automatic counting procedure may be used to monitor the quality of metaphases over time and to set limits for band number on routine preparations acceptable for analysis.

Automation↗

Evidence for a cooperation between adenosine A2 receptors and beta 1-adrenoceptors on cardiac automaticity in the isolated right ventricle of the rat.

1. The effects of the adenosine receptor agonists, 5'-N-ethyl-carboxamidoadenosine (NECA) and 2-[4-(2-carboxyethyl)phenethylamino]-5'-N-ethylcarboxamidoadenosin e (CGS-21680) on ventricular automaticity induced by a local injury in the isolated right ventricle of the rat were studied. 2. In concentrations ranging from 0.1 to 100 nM, NECA significantly increased ventricular automaticity. This effect was more reproducible when the adenosine receptor antagonist 1,3-dipropyl-8-cyclopentylxanthine (DPCPX) was present at 5 nM, a concentration that blocks A1 adenosine receptors. 3. The excitatory effect of NECA was not observed when DPCPX was present at a concentration of 10 microM, which antagonizes both A1 and A2 adenosine receptors, as well as when rats were reserpinized. 4. In reserpinized rats, NECA increased ventricular automaticity in the presence of isoprenaline and the beta 2-adrenoceptor antagonist, ICI-118,551, but not in the presence of the beta 1-adrenoceptor antagonists, bisoprolol or atenolol. 5. The A 2s-selective adenosine receptor agonist, CGS-21680 (0.1 nM-10 microM) was devoid of excitatory effect on ventricular automaticity. Binding studies of this compound to the rat ventricular membranes revealed that in the preparation there was no specific binding. 6. These results suggest that the excitatory effect of NECA on ectopic ventricular automaticity is dependent on endogenous catecholamines and is mediated by an A2 adenosine receptor which is in some way 'linked' to the beta 1-adrenoceptor. These A2 receptors do not appear to be of the A2a adenosine receptor subtype.

Adenosine↗

An integrated dual sensor system automatically optimized by target rate histogram.

The use of combined sensors and advanced algorithms using different principles can improve rate performance over a single sensor system. Combinations of sensors and more sophisticated algorithms, however, invariably increase the complexity of pacemaker programming. An automatically optimized combined minute ventilation and activity DDDR pacemaker was developed to minimize repeated sensor adjustment. The device used subthreshold (below cardiac stimulation threshold) lead impedance to detect lead configuration at implantation automatically, followed by "implant management," including setting of lead polarity and initiation of DDDR pacing. Automatic sensor adaptation was achieved by programming a "target rate histogram" based on the patient's activity level and frequency of exertion, and the rate profile optimization process matched the recorded integrated sensor response to the target rate histogram profile. In nine patients implanted with the DX2 pacemakers, the implant management gave 100% accuracy in the detection of lead polarity. Rate profile optimization automatically increased the pacing rate during exercise between discharge and 3-month follow-up (hall walk: 78 +/- 3 vs 98 +/- 3 beats/min, and maximal treadmill exercise: 89 +/- 6 vs 115 +/- 5 beats/min, P < 0.001) with a significant increase in exercise duration during maximal exercise (7.18 +/- 1 min vs 9.56 +/- 2 min, P = 0.05). The accuracy of rate profile optimization versus manual programming was assessed at 1 month, and there was no significant difference between pacing rate kinetics and maximal pacing rate between the two methods of programming. In conclusion, pacemaker automaticity can be initiated at implantation and the self-optimized rate adaptive response appeared to be comparable to that derived from a manual programming procedure, which may reduce the need to perform time consuming sensor programming.

Aged↗

A computer-assisted automatic method for myelinated nerve fiber morphometry.

This paper describes a computer-assisted automatic method developed for myelinated nerve fiber morphometry. IBAS image analysis system was used. One-micron thick sections of sural nerve were stained with p-phenylenediamine. Dark myelin sheaths, standing out against a pale background, were identified by a binary transformation of the computer-stored image. Different parameters of the fibers as well as of the axons can be measured. The automatic system allows operator-interactive manipulation, if required, to avoid inclusion of wrong histologic structures. A large spectrum of statistics facilities are available. We performed a comparison between automatic and semi-automatic analysis. Measurements resulted virtually overlapping, but time was three to four times shorter with automatic procedure. The method here described is accurate and reliable, and permits economy of time and effort.

Biopsy↗