Lillelundsteensen6160

High frame rate (HFR) echo-particle image velocimetry (echoPIV) is a promising tool for measuring intracardiac blood flow dynamics. In this study we investigate the optimal ultrasound contrast agent (UCA SonoVue®) infusion rate and acoustic output to use for HFR echoPIV (PRF = 4900 Hz) in the left ventricle (LV) of patients. Three infusion rates (0.3, 0.6 and 1.2 ml/min) and five acoustic output amplitudes (by varying transmit voltage 5V, 10V, 15V, 20V and 30V - corresponding to Mechanical Indices of 0.01, 0.02, 0.03, 0.04 and 0.06 at 60 mm depth) were tested in 20 patients admitted for symptoms of heart failure. We assess the accuracy of HFR echoPIV against pulsed wave Doppler acquisitions obtained for mitral inflow and aortic outflow. In terms of image quality, the 1.2 ml/min infusion rate provided the highest contrast-to-background (CBR) ratio (3 dB improvement over 0.3 ml/min). The highest acoustic output tested resulted in the lowest CBR. Increased acoustic output also resulted in increased microbubble disruption. For the echoPIV results, the 1.2 ml/min infusion rate provided the best vector quality and accuracy; and mid-range acoustic outputs (corresponding to 15V-20V transmit voltages) provided the best agreement with the pulsed wave Doppler. Overall, the highest infusion rate (1.2 ml/min) and mid-range acoustic output amplitudes provided the best image quality and echoPIV results.We introduce a generative smoothness regularization on manifolds (SToRM) model for the recovery of dynamic image data from highly undersampled measurements. The model assumes that the images in the dataset are non-linear mappings of low-dimensional latent vectors. We use the deep convolutional neural network (CNN) to represent the non-linear transformation. The parameters of the generator as well as the low-dimensional latent vectors are jointly estimated only from the undersampled measurements. This approach is different from traditional CNN approaches that require extensive fully sampled training data. We penalize the norm of the gradients of the non-linear mapping to constrain the manifold to be smooth, while temporal gradients of the latent vectors are penalized to obtain a smoothly varying time-series. The proposed scheme brings in the spatial regularization provided by the convolutional network. The main benefit of the proposed scheme is the improvement in image quality and the orders-of-magnitude reduction in memory demand compared to traditional manifold models. To minimize the computational complexity of the algorithm, we introduce an efficient progressive training-in-time approach and an approximate cost function. These approaches speed up the image reconstructions and offers better reconstruction performance.Automated segmentation of brain glioma plays an active role in diagnosis decision, progression monitoring and surgery planning. Based on deep neural networks, previous studies have shown promising technologies for brain glioma segmentation. However, these approaches lack powerful strategies to incorporate contextual information of tumor cells and their surrounding, which has been proven as a fundamental cue to deal with local ambiguity. In this work, we propose a novel approach named Context-Aware Network (CANet) for brain glioma segmentation. CANet captures high dimensional and discriminative features with contexts from both the convolutional space and feature interaction graphs. We further propose context guided attentive conditional random fields which can selectively aggregate features. We evaluate our method using publicly accessible brain glioma segmentation datasets BRATS2017, BRATS2018 and BRATS2019. The experimental results show that the proposed algorithm has better or competitive performance against several State-of-The-Art approaches under different segmentation metrics on the training and validation sets.Rheumatology workforces are increasingly challenged by too few physicians in face of the growing burden of rheumatic and musculoskeletal diseases (RMDs). Rheumatology is one of the most frequent non-surgical specialty referrals and has the longest wait times for subspecialists. We used a population-based approach to describe changes in the rheumatology workforce, patient volumes and geographic variation in the supply of and access to rheumatologists, in Ontario, Canada, between 2000 and 2019, and projected changes in supply by 2030. Over time, we observed greater feminization of the workforce and increasing age of workforce members. We identified a large regional variation in rheumatology supply. Fewer new patients are seen annually, which likely contributes to increasing wait times and reduced access to care. Strategies and policies to raise the critical mass and improve regional distribution of supply to effectively provide rheumatology care and support the healthcare delivery of patients with RMDs are needed.

Most Canadian medical schools allocate admission based on province or territory of residence. This may result in inequities in access to medical school, disadvantaging highly qualified students from particular provinces.

The number of medical school spaces available to applicants from each province and territory was compared to the total number of available spaces in Canada, the regional application pressure and enrolment in 2017/2018.

There is differential access to medical schools based on the absolute numbers of available spaces and application pressure. Applicants from Prince Edward Island are afforded the greatest number of spaces per 100,000 population aged 20 to 29 (5,568.8). Applicants from Ontario experience the lowest ratio of available spaces to relevant population (54.3).

Health workforce policy must balance equity and regional social accountability. Privileging regional residence over academic aptitude and personal characteristics may be justified by strong evidence that these applicants are likely to serve populations that would otherwise be underserved.

The availability of medical school spaces in Canada differs as a function of the province or territory from which applicants apply. Determining whether this differential is justified requires appraisal of the consequences of the policies with respect to their goals.

The availability of medical school spaces in Canada differs as a function of the province or territory from which applicants apply. Determining whether this differential is justified requires appraisal of the consequences of the policies with respect to their goals.In Canada, chimeric antigen receptor (CAR) T-cell therapy was recommended for funding for the treatment of select hematological cancers. Canadian hospitals have limited experience and capacity in administrating this therapy. We conducted a qualitative interview-based study with stakeholders in Canada. Questions were asked related to the development, administration, implementation and logistical planning of CAR T-cell therapy. Results were summarized into four main themes (i) novel; (ii) patient characteristics and the delivery of care; (iii) processes from "bench-to-bedside"; and (iv) the future state, including both challenges and recommendations to ensure sustainability. Valuable perspectives from stakeholders highlight some of the unique challenges to implementing a highly personalized and expensive-to-deliver therapy.Guidelines and legislation prescribe how hospitals should conduct critical incident disclosures with patients. However, variation in secondary disclosure implementation can occur. Using the Consolidated Framework for Implementation Research, this qualitative multiple-case study explored the factors that impact Ontario hospitals' secondary disclosure of critical incidents. The study concludes that while hospitals generally implement guidelines consistently, complex environments and differing professional backgrounds lead to variations. Consequently, hospitals should address timing delays, improve documentation and enhance support to clinicians who conduct the disclosures. Policy makers should consider the benefits and challenges of written disclosure, and offering patients a choice in the setting where disclosure occurs, as potential improvements.The role of paramedics, including select paramedics providing primary and preventive care in homes and community settings, is evolving in health systems around the world. These developments are associated with improvements in health outcomes, improved access to services and reduced emergency department use. Veliparib nmr Building on these existing trends in paramedicine, and because social conditions contribute to illness and are strong predictors of future health service use, addressing patients' social needs should be integrated into core paramedic practice in Canada. We discuss how paramedic education, culture and governance could better enable paramedics to address the social determinants of health.

Healthcare spending is concentrated, with a minority of the population accounting for the majority of healthcare costs.

The authors modelled the impact of high resource user (HRU) prevention strategies within five years using the validated High Resource User Population Risk Tool.

The authors estimated 758,000 new HRUs in Ontario from 2013-2014 to 2018-2019, resulting in $16.20 billion in healthcare costs (Canadian dollars 2016). The prevention approach that had the largest reduction in HRUs was targeting health-risk behaviours.

This study demonstrates the use of a policy tool by decision makers to support prevention approaches that consider the impact on HRUs and estimated healthcare costs.

This study demonstrates the use of a policy tool by decision makers to support prevention approaches that consider the impact on HRUs and estimated healthcare costs.Increasing private healthcare financing has been suggested as a solution toward improving healthcare quality and access within the Canadian healthcare system. However, Lee et al. (2021) find no evidence that increasing private financing would address the challenges faced by Canadian healthcare. We suggest turning our focus away from reforms that solely increase private healthcare financing and toward evidence-based delivery-system reforms to address both quality and sustainability. We present examples and supporting evidence of the effectiveness of patient-, physician-, organization- and system-level strategies. Changes should engage physicians and be implemented across Canada to facilitate a cultural shift toward experimentation and high-value care delivery.Medicare is a publicly funded healthcare system that is a source of national pride in Canada; however, Canadians are increasingly concerned about its performance and sustainability. One proposed solution is private financing (including both private for-profit insurance and private out-of-pocket financing) that would fundamentally change medicare. We investigate international experiences to determine if associations exist between the degree of private spending and two of the core values of medicare - universality and accessibility - as well as the values of equity and quality. We further investigate the impact of private spending on overall health system performance, health outcomes and health expenditure growth rates. Private financing (both private for-profit insurance and private out-of-pocket financing) was found to negatively affect universality, equity, accessibility and quality of care. Increased private financing was not associated with improved health outcomes, nor did it reduce health expenditure growth.