Neonatal ICU antibiotic use trends within an integrated delivery network.

Background And Objectives: There is a need for robust antibiotic stewardship programs (ASPs) in the neonatal population. This study's objectives were to assess neonatal antibiotic use practices over an extended period across an integrated delivery network (IDN), including six Neonatal Intensive Care Units (NICUs), to identify those most successful practices reducing use rates.

Methods: A retrospective cohort study was conducted, including 15,015 NICU admissions from an integrated delivery network, across six hospitals over eight years (50% Level III and 50% Level II) computing antibiotic use rates (AURs) stratified by usage: in the first few days of the stay vs.

A Retrospective Cohort Study of Clinical Factors Associated with Transitions of Care among COVID-19 Patients.

Coronavirus Disease 2019 (COVID-19) is an international health crisis. In this article, we report on patient characteristics associated with care transitions of: 1) hospital admission from the emergency department (ED) and 2) escalation to the intensive care unit (ICU). Analysis of data from the electronic medical record (EMR) was performed for patients with COVID-19 seen in the ED of a large Western U.

Utilizing machine learning to improve clinical trial design for acute respiratory distress syndrome.

Heterogeneous patient populations, complex pharmacology and low recruitment rates in the Intensive Care Unit (ICU) have led to the failure of many clinical trials. Recently, machine learning (ML) emerged as a new technology to process and identify big data relationships, enabling a new era in clinical trial design. In this study, we designed a ML model for predictively stratifying acute respiratory distress syndrome (ARDS) patients, ultimately reducing the required number of patients by increasing statistical power through cohort homogeneity.

Image Registration for Microwave Tomography of the Breast Using Priors From Nonsimultaneous Previous Magnetic Resonance Images.

Microwave imaging is a low-cost imaging method that has shown promise for breast imaging and, in particular, neoadjuvant chemotherapy monitoring. The early studies of microwave imaging in the therapy monitoring setting are encouraging. For the neoadjuvant therapy application, it would be desirable to achieve the most accurate possible characterization of the tissue properties.

Efficient Simultaneous Reconstruction of Time-Varying Images and Electrode Contact Impedances in Electrical Impedance Tomography.

Objective: In electrical impedance tomography (EIT), we apply patterns of currents on a set of electrodes at the external boundary of an object, measure the resulting potentials at the electrodes, and, given the aggregate dataset, reconstruct the complex conductivity and permittivity within the object. It is possible to maximize sensitivity to internal conductivity changes by simultaneously applying currents and measuring potentials on all electrodes but this approach also maximizes sensitivity to changes in impedance at the interface.

Methods: We have, therefore, developed algorithms to assess contact impedance changes at the interface as well as to efficiently and simultaneously reconstruct internal conductivity/permittivity changes within the body.

Detection of small bleeds in the brain with electrical impedance tomography.

In this paper, we describe and assess feasibility of instrumentation and algorithms for detecting bleeding due to hemorrhagic strokes and traumatic brain injury using electrical impedance tomography, a novel biomedical diagnostic modality in which the body is probed noninvasively with generally imperceptible alternating currents applied in patterns to a set of electrodes placed in contact with the skin. We focus on the GENESIS instrument developed by GE Global Research and on the achievability of our goal to detect a bleed in the center of the head with a volume of several ml. Our main topic is compensation for the large changes in voltages that tend to occur when the electrodes are in contact with biological media, specifically either human subjects or with vegetable matter proxies which seem to exhibit the same 'drift' phenomenon.

Comparison of impedance measurements near the skin of newborns and adults.

Electrical impedance tomography (EIT) is a non-invasive imaging technology that has been extensively studied for monitoring lung function of neonatal and adult subjects, especially in neonatal intensive care unit (NICU) and intensive care unit (ICU) environments. The sources of the total impedance in these applications include internal organs, near-boundary tissues, electrode-skin impedance, electrodes and conducting wires. This total impedance must be considered for system design and setting voltage gain since it will contribute to the measured voltage.

Real-time 3D electrical impedance imaging for ventilation monitoring of the lung: Pilot study.

We report an Electrical Impedance Tomography device capable of detecting gravity-induced regional ventilation changes in real-time without averaging or using a contrast medium. Changes in lung ventilation are demonstrated in right and left lateral decubitus position and compared to those seen in an upright and supine normal subject.

Prediction of mortality from respiratory distress among long-term mechanically ventilated patients.

With the advent of inexpensive storage, pervasive networking, and wireless devices, it is now possible to store a large proportion of the medical data that is collected in the intensive care unit (ICU). These data sets can be used as valuable resources for developing and validating predictive analytics. In this report, we focus on the problem of prediction of mortality from respiratory distress among long-term mechanically ventilated patients using data from the publicly-available MIMIC-II database.

Real-time 3D electrical impedance imaging for ventilation and perfusion of the lung in lateral decubitus position.

We report a prototype Electrical Impedance Imaging System. It is able to detect the gravity-induced changes in the distributions of perfusion and ventilation in the lung between supine and lateral decubitus positions. Impedance data were collected on healthy volunteer subjects and 3D reconstructed images were produced in real-time, 20 frames per second on site, without using averaging or a contrast agent.

Multi-channel electrical impedance tomography for regional tissue hydration monitoring.

Poor assessment of hydration status during hemodialysis can lead to under- or over-hydration in patients with consequences of increased morbidity and mortality. In current practice, fluid management is largely based on clinical assessments to estimate dry weight (normal hydration body weight). However, hemodialysis patients usually have co-morbidities that can make the signs of fluid status ambiguous.

Combined optical and X-ray tomosynthesis breast imaging.

Purpose: To explore the optical and physiologic properties of normal and lesion-bearing breasts by using a combined optical and digital breast tomosynthesis (DBT) imaging system.

Materials And Methods: Institutional review board approval and patient informed consent were obtained for this HIPAA-compliant study. Combined optical and tomosynthesis imaging analysis was performed in 189 breasts from 125 subjects (mean age, 56 years ± 13 [standard deviation]), including 138 breasts with negative findings and 51 breasts with lesions.

Methods for compensating for variable electrode contact in EIT.

Electrical impedance tomography (EIT) is an imaging modality that currently shows promise for the detection and characterization of breast cancer. A very significant problem in EIT imaging is the proper modeling of the interface between the body and the electrodes. We have found empirically that it is very difficult, in a clinical setting, to assure that all electrodes make satisfactory contact with the body.

A two-layered forward model of tissue for electrical impedance tomography.

Electrical impedance tomography is being explored as a technique to detect breast cancer, exploiting the differences in admittivity between normal tissue and tumors. In this paper, the geometry is modeled as an infinite half space under a hand-held probe. A forward solution and a reconstruction algorithm for this geometry were developed previously by Mueller et al (1999 IEEE Trans.

Combined optical imaging and mammography of the healthy breast: optical contrast derived from breast structure and compression.

In this paper, we report new progress in developing the instrument and software platform of a combined X-ray mammography/diffuse optical breast imaging system. Particularly, we focus on system validation using a series of balloon phantom experiments and the optical image analysis of 49 healthy patients. Using the finite-element method for forward modeling and a regularized Gauss-Newton method for parameter reconstruction, we recovered the inclusions inside the phantom and the hemoglobin images of the human breasts.

Regional admittivity spectra with tomosynthesis images for breast cancer detection: preliminary patient study.

It has been known for some time that many tumors have a significantly different conductivity and permittivity from surrounding normal tissue. This high "contrast" in tissue electrical properties, occurring between a few kilohertz and several megahertz, may permit differentiating malignant from benign tissues. Here we show the ability of electrical impedance spectroscopy (EIS) to roughly localize and clearly distinguish cancers from normal tissues and benign lesions.

Robust linearized image reconstruction for multifrequency EIT of the breast.

Electrical impedance tomography (EIT) is a developing imaging modality that is beginning to show promise for detecting and characterizing tumors in the breast. At Rensselaer Polytechnic Institute, we have developed a combined EIT-tomosynthesis system that allows for the coregistered and simultaneous analysis of the breast using EIT and X-ray imaging. A significant challenge in EIT is the design of computationally efficient image reconstruction algorithms which are robust to various forms of model mismatch.

An analytical layered forward model for breasts in electrical impedance tomography.

Electrical impedance tomography (EIT) can be used to determine the admittivity distribution within the breast from measurements made on its surface. It has been reported that the electrical impedance spectrum of normal breast tissue is significantly different from that of malignant tissue, making EIT a candidate technology for breast cancer detection. The inhomogeneous structure of breasts, with thin low-admittivity skin layers covering the relatively high-admittivity tissue inside, makes the breast imaging problem difficult.

Estimation and statistical bounds for three-dimensional polar shapes in diffuse optical tomography.

Voxel-based reconstructions in diffuse optical tomography (DOT) using a quadratic regularization functional tend to produce very smooth images due to the attenuation of high spatial frequencies. This then causes difficulty in estimating the spatial extent and contrast of anomalous regions such as tumors. Given an assumption that the target image is piecewise constant, we can employ a parametric model to estimate the boundaries and contrast of an inhomogeneity directly.

Layered model for breasts in electrical impedance tomography.

We are presently using Electrical Impedance Tomography as a technique for breast cancer imaging, determining the admittivity distribution inside the breast. The admittivities we observed in compressed breasts in EIT were lower than those seen in earlier studies involving whole chest imaging. We attribute this to a thin low admittance skin layer which dominates in compressed breasts.

Regional admittivity spectra with tomosynthesis images for breast cancer detection.

Because the electrical properties of many breast tumors are different from those of surrounding, normal tissue, imaging these properties may provide useful diagnostic information. At the present time, X-ray mammography is the standard imaging modality used for breast cancer screening. The interpretation of EIT imaging is thus enhanced by its use together with x-ray mammography in the same geometry.

The complete electrode model for imaging and electrode contact compensation in electrical impedance tomography.

Electrical Impedance Tomography (EIT) is an imaging modality which currently shows promise for the detection and characterization of breast cancer. A very significant problem in EIT imaging is the proper modeling of the interface between the body and the electrodes. We have found empirically that it is very difficult, in a clinical setting, to assure that all electrodes make satisfactory contact with the body.

The complete electrode model for EIT in a mammography geometry.

We have developed an EIT system for simultaneous use in a mammography examination, allowing for highly accurate co-registration between the two modalities. In this pre-clinical study, we investigate the importance of properly modeling the interface between the electrodes and the medium being imaged. We have implemented the complete electrode model for a parallel-plane mammography geometry, in which currents are injected into the medium through two planar sets of electrodes above and below the medium.

Spatio-temporal imaging of the hemoglobin in the compressed breast with diffuse optical tomography.

We develop algorithms for imaging the time-varying optical absorption within the breast given diffuse optical tomographic data collected over a time span that is long compared to the dynamics of the medium. Multispectral measurements allow for the determination of the time-varying total hemoglobin concentration and of oxygen saturation. To facilitate the image reconstruction, we decompose the hemodynamics in time into a linear combination of spatio-temporal basis functions, the coefficients of which are estimated using all of the data simultaneously, making use of a Newton-based nonlinear optimization algorithm.