Infrared temperature measurement in the ear canal with the DIATEK 9000 Instatemp and the DIATEK 9000 Thermoguide. Comparison with methods of temperature measurement in other body parts

Temperature of the tympanic membrane is recommended as a "gold standard" of core-temperature recording. However, use of temperature probes in the auditory canal may lead to damage of tympanic membrane. Temperature measurement in the auditory canal with infrared thermometry does not pose this risk. Furthermore it is easy to perform and not very time-consuming. For this reason infrared thermometry of the auditory canal is becoming increasingly popular in clinical practice. We evaluated two infrared thermometers-the Diatek 9000 Thermoguide and the Diatek 9000 Instatemp-regarding factors influencing agreement with conventional tympanic temperature measurement and other core-temperature recording sites. In addition, we systematically evaluated user dependent factors that influence the agreement with the tympanic temperature. MATERIALS AND METHODS: In 20 volunteers we evaluated the influence of three factors: duration of the devices in the auditory canal before taking temperature (0 or 5 s), interval between two following recordings (30, 60, 90, 120, 180 s) and positioning of the grip relative to the auditory-canal axis (0, 60, 180 and 270 degrees). Agreement with tympanic contact probes (Mon-a-therm tympanic) in the contralateral ear was investigated in 100 postoperative patients. Comparative readings with rectal (YSI series 400) and esophageal (Mon-a-therm esophageal stethoscope with temperature sensor) probes were done in 100 patients in the ICU. The method of Bland and Altman was taken for comparison. RESULTS: Shortening of the interval between two consecutive readings led to increasing differences between the two measurements with the second reading decreasing. A similar effect was seen when positioning the infrared thermometers in the auditory canal before taking temperatures: after 5 s the recorded temperatures were significantly lower than temperature recordings taken immediately. Rotation of the devices out of the telephone handle position led to increasing lack of agreement between infrared thermometry and contact probes. Mean differences between infrared thermometry (Instatemp and Thermoguide, CAL-Mode) and tympanic probes were -0.41 +/- 0.67 degree C (2 SD) and -0.43 +/- 0.70 degree C, respectively. Mean differences between the Thermoquide (Rectal-Mode) and rectal probe were -0.19 +/- 0.72 degree C, and between the Thermoguide (Core Mode) and esophageal probe -0.13 +/- 0.74 degree C. DISCUSSION: Although easy to use, infrared thermometry requires careful handling. To obtain optimal recordings, the time between two consecutive readings should not be less than two min. Recordings should be taken immediately after positioning the devices in the auditory canal. Best results are obtained in the 60 degrees position with the grip of the devices following the ramus mandibulae (telephone handle position). The lower readings of infrared thermometry compared with tympanic contact probes indicate that the readings obtained represent the temperature of the auditory canal rather than of the tympanic membrane itself. To compensate for underestimation of core temperature by infrared thermometry, the results obtained are corrected and transferred into core-equivalent temperatures. This data correction reduces mean differences between infrared recordings and traditional core-temperature monitoring, but leaves limits of agreement between the two methods uninfluenced.     

Automated property verification for large scale B models with ProB

In this paper we describe the successful application of the ProB tool for data validation in several industrial applications. The initial case study centred on the San Juan metro system installed by Siemens. The control software was developed and formally proven with B. However, the development contains certain assumptions about the actual rail network topology which have to be validated separately in order to ensure safe operation. For this task, Siemens has developed custom proof rules for Atelier B. Atelier B, however, was unable to deal with about 80 properties of the deployment (running out of memory). These properties thus had to be validated by hand at great expense, and they need to be revalidated whenever the rail network infrastructure changes. In this paper we show how we were able to use ProB to validate all of the about 300 properties of the San Juan deployment, detecting exactly the same faults automatically in a few minutes that were manually uncovered in about one man-month. We have repeated this task for three ongoing projects at Siemens, notably the ongoing automatisation of the line 1 of the Paris Métro. Here again, about a man month of effort has been replaced by a few minutes of computation. This achievement required the extension of the ProB kernel for large sets as well as an improved constraint propagation algorithm. We also outline some of the effort and features that were required in moving from a tool capable of dealing with medium-sized examples towards a tool able to deal with actual industrial specifications. We also describe the issue of validating ProB, so that it can be integrated into the SIL4 development chain at Siemens.     

Solving Third Order Differential Equations with Maximal Symmetry Group

The largest group of Lie symmetries that a third-order ordinary differential equation (ode) may allow has seven parameters. Equations sharing this property belong to a single equivalence class with a canonical representative v ^′′′(u)=0. Due to this simple canonical form, any equation belonging to this equivalence class may be identified in terms of certain constraints for its coefficients. Furthermore a set of equations for the transformation functions to canonical form may be set up for which large classes of solutions may be determined algorithmically. Based on these steps a solution algorithm is described for any equation with this symmetry type which resembles a similar scheme for second order equations with projective symmetry group. Received March 9, 2000; revised June 8, 2000     

Using visual design experts in critique-based evaluation of 2D vector visualization methods

We describe an experiment in which art and illustration experts evaluated six 2D vector visualization methods. We found that these expert critiques mirrored previously recorded experimental results; these findings support that using artists, visual designers and illustrators to critique scientific visualizations can be faster and more productive than quantitative user studies. Our participants successfully evaluated how well the given methods would let users complete a given set of tasks. Our results show a statistically significant correlation with a previous objective study: designers' subjective predictions of user performance by these methods match users measured performance. The experts improved the evaluation by providing insights into the reasons for the effectiveness of each visualization method and suggesting specific improvements.     

Scientific sketching for collaborative VR visualization design

We present four studies investigating tools and methodologies for artist-scientist-technologist collaboration in designing multivariate, virtual reality (VR) visualizations. Design study 1 identifies the promise of 3D drawing-style interfaces for VR design and also establishes limitations of these tools with respect to precision and support for animation. Design study 2 explores animating artist-created visualization designs with scientific 3D fluid flow data. While results captured an accurate sense of flow that was advantageous as compared to the results of study 1, the potential for visual exploration using the design tools tested was limited. Design study 3 reveals the importance of a new 3D interface that overcomes the precision limitation found in study 1 while remaining accessible to artist collaborators. Drawing upon previous results, design study 4 engages collaborative teams in a design process that begins with traditional paper sketching and moves to animated, interactive, VR prototypes "sketched" by designers in VR using interactive 3D tools. Conclusions from these four studies identify important characteristics of effective artist-accessible VR visualization design tools and lead to a proposed formalized methodology for successful collaborative design that we expect to be useful in guiding future collaborations. We call this proposed methodology Scientific Sketching.     

Interactive volume exploration for feature detection and quantification in industrial CT data

This paper presents a novel method for interactive exploration of industrial CT volumes such as cast metal parts, with the goal of interactively detecting, classifying, and quantifying features using a visualization-driven approach. The standard approach for defect detection builds on region growing, which requires manually tuning parameters such as target ranges for density and size, variance, as well as the specification of seed points. If the results are not satisfactory, region growing must be performed again with different parameters. In contrast, our method allows interactive exploration of the parameter space, completely separated from region growing in an unattended pre-processing stage. The pre-computed feature volume tracks a feature size curve for each voxel over time, which is identified with the main region growing parameter such as variance. A novel 3D transfer function domain over (density, feature size, time) allows for interactive exploration of feature classes. Features and feature size curves can also be explored individually, which helps with transfer function specification and allows coloring individual features and disabling features resulting from CT artifacts. Based on the classification obtained through exploration, the classified features can be quantified immediately.     

Treatment of acute lymphoblastic leukemia. 30 years' experience at St. Jude Children's Research Hospital

BACKGROUND: Therapy for childhood lymphoblastic leukemia has evolved during the past three decades, but key questions about what are the least toxic, most effective forms of treatment remain unanswered because of the lack of comprehensive follow-up information. METHODS: To assess long-term outcome in the series of clinical trials conducted at St. Jude Hospital, we compared the results of treatment typical of four eras: exploratory combination chemotherapy (era 1, 1962 to 1966; 91 patients), regimens for the control of meningeal leukemia (era 2, 1967 to 1979; 825 patients), limited intensification of therapy (era 3, 1979 to 1983; 428 patients), and extended intensification of therapy (era 4, 1984 to 1988; 358 patients). ("Intensification" refers to strategies of systemic chemotherapy that are more aggressive than conventional ones.) The major end points were survival and event-free survival; we also calculated the relative risk of treatment failure and the rate of relapse or death after treatment ended (post-treatment failure rate). RESULTS: The probability of event-free survival improved significantly in each successive era (P < 0.001 by the log-rank test), reaching 71 percent in era 4. There was a decrease of approximately 50 percent in the risk of treatment failure from one era to the next in each subgroup of patients defined according to different combinations of the leukocyte count, race, age, and sex. Leukemia appeared to be eradicated in patients who remained in complete remission for three years or more after treatment in era 4. The incidence of death due to nonleukemic causes remained 4 to 6 percent despite the trend toward more intensive treatment. An estimated 765 patients (45 percent) are long-term survivors; most of them (80 percent) have no health problems related to leukemia or its treatment. CONCLUSIONS: The development and successful application of preventive therapy for meningeal leukemia, followed by the intensification of systemic chemotherapy, has progressively improved the rate of cure of childhood lymphoblastic leukemia, with relatively few adverse sequelae.     

Effect of set-up error on the dose across the junction of matching cranial-spinal fields in the treatment of medulloblastoma

PURPOSE: The effect of systematic and stochastic setup error on the dose delivered to the gap region for the three field radiation treatment of medulloblastoma is studied. The consequences of such setup error is discussed. METHODS AND MATERIALS: The treatment of medulloblastoma is typically a 3 field technique, in which two lateral cranial fields are matched with a spine field. The x-ray dose delivered to the region between the matched fields depends upon the gap size. The choice of the gap width between the cranial and spinal fields is controversial. It is currently a compromise between minimizing the risk of dose hot spots to the spine, and the associated clinical complications, as well as the magnitude of cold spots (underdosing) across the gap, with the associated risk of disease recurrence. In this paper, we examine the effect of gap width with a moving junction, referred to as "field feathering", on the dose across the field junction for a 6MV photon beam. In addition, we have studied 129 portal films and 40 simulation films to assess the accuracy and precision of patient setup during treatment with a plan involving feathered fields. Selected landmarks observable on both portal and simulation films were identified and the variation in the distances to the field edges measured. The distribution of patient setup error was convoluted with the beam profiles for a 6MV linac. These convoluted field edges were used obtain dose profiles across the gap region as a function of gap separation. The consequences for therapy are discussed. In addition, analysis of patient setup error on an alternative treatment involving beam modifiers to broaden the beam penumbra is discussed. RESULTS: The magnitude of the spatial stochastic and systematic setup error was determined to be approximately three and two millimeters respectively. The dosimetric consequences of patient setup error lead to over and under dosing in the spinal gap region for the three field technique. The degree of under or over dose depends on the nature and magnitude of the patient setup error. CONCLUSIONS: The effect of patient setup error can lead to significant dosimetric errors in the dose to the gap region depending on the magnitude of the setup errors. The effective over and under dose can be compensated by the use beams modifiers such as a beam spoiler or vibrating jaws.     

Learning Perceptrons and Piecewise Linear Classifiers Sensitive to Example Dependent Costs

This article considers the cost dependent construction of linear and piecewise linear classifiers. Classical learning algorithms from the fields of artificial neural networks and machine learning consider either no costs at all or allow only costs that depend on the classes of the examples that are used for learning. In contrast to class dependent costs, we consider costs that are example, i.e. feature and class dependent. We present a cost sensitive extension of a modified version of the well-known perceptron algorithm that can also be applied in cases, where the classes are linearly non-separable. We also present an extended version of the hybrid learning algorithm DIPOL, that can be applied in the case of linear non-separability, multi-modal class distributions, and multi-class learning problems. We show that the consideration of example dependent costs is a true extension of class dependent costs. The approach is general and can be extended to other neural network architectures like multi-layer perceptrons and radial basis function networks.