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ABSTRACT: Ecosystem models have been developed for assessment and management in a wide variety of environments. As model complexity increases, it becomes more difficult to trace how imperfect knowledge of internal model parameters, data inputs, or relationships among parameters might impact model results, affecting predictions and subsequent management decisions. Sensitivity analysis is an essential component of model evaluation, particularly when models are used to make management decisions. Results should be expressed as probabilities and should realistically account for uncertainty. When models are particularly complex, this can be difficult to do and to present in ways that do not obfuscate essential results. We conducted a sensitivity analysis of the Ecosystem Diagnosis and Treatment (EDT) model, which predicts salmon productivity and capacity as a function of ecosystem conditions. We used a novel "structured sensitivity analysis" approach that is particularly useful for very complex models or those with an abundance of interconnected parameters. We identified small, medium, and large plausible ranges for both input data and model parameters. Using a Monte Carlo approach, we explored the variation in output, prediction intervals, and sensitivity indices, given these plausible input distributions. The analyses indicated that, as a consequence of internal parameter uncertainty, EDT productivity and capacity predictions lack the precision needed for many management applications. However, EDT prioritization of reaches for preservation or restoration was more robust to given input uncertainties, indicating that EDT may be more useful as a relative measure of fish performance than as an absolute measure. Like all large models, if EDT output is to be used as input to other models or management tools it is important to explicitly incorporate the uncertainty and sensitivity analyses into such secondary analyses. Sensitivity analyses should become standard operating procedure for evaluation of ecosystem models.
Ecological Applications 03/2010; 20(2):465-82. · 5.10 Impact Factor
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ABSTRACT: Evaluate the role of two-dimensional echocardiography and electrocardiographically (ECG)-gated contrast-enhanced multislice computed tomographic (MSCT) cardiac imaging to assess cardiac anatomy, specifically pulmonary venous anatomy and left atrial thrombus, in a selected group of patients before catheter-based atrial fibrillation ablation.
Left atrial anatomy and associated findings in 34 consecutive patients scheduled for electrophysiologic testing who underwent both echocardiography and ECG-gated 16-slice MSCT cardiac imaging were retrospectively compared. Results from two-dimensional transthoracic echocardiography (TTE), cardiac MSCT, electrophysiologic study (EPS), and transesophageal echocardiography (TEE) (when performed) were taken from the official medical record without prior knowledge of this study when interpretation was rendered for clinical use. Electronic record review included: presence of left atrial thrombus (defined as constant filling defect on at least two echocardiographic views or filling defect on computed tomography) and location, pulmonary venous anatomy, and other cardiac, mediastinal, or pulmonary abnormalities.
Left atrial thrombus was identified by cardiac MSCT alone in five patients (15%). Pulmonary venous variants were identified with cardiac MSCT in two patients (6%). Both MSCT and echocardiography were normal in 17 subjects (79%). Echocardiography was better at identifying associated valvular abnormalities that were seen in 10 patients (29%). Cardiac MSCT angiography alone identified other cardiac and noncardiac abnormalities, including suspicious pulmonary malignancy, mediastinal adenopathy, and coronary stenosis in 15 patients (44%).
Echocardiography and cardiac MSCT angiography often provide complimentary findings during the preprocedural evaluation for patients with atrial fibrillation requiring ablation. Cardiac MSCT may provide significant additional information about the left atrium, mediastinum, coronary circulation, and visualized lung fields. Based on this study, we would advise that patients considered for radiofrequency ablation for uncontrolled right atrial fibrillation have both echocardiography and ECG-gated contrast-enhanced cardiac MSCT performed as part of the preprocedure evaluation.
Academic Radiology 08/2008; 15(7):835-43. · 1.69 Impact Factor
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ABSTRACT: We sought to assess the performance of a real-time interactive pulmonary nodule analysis system for evaluation of chest digital radiographic (DR) images in a routine clinical environment.
A real-time interactive pulmonary nodule analysis system for chest DR image softcopy reading (IQQA-Chest; EDDA Technology, Princeton Junction, NJ) was used in daily practice with a Picture Archiving and Communication System in a National Cancer Institute-designated cancer teaching hospital. Patients referred for follow-up of known cancer underwent digital chest radiography. Posteroanterior and lateral DR images were first read by resident radiologists along with experienced chest radiologists using a Picture Archiving and Communication System work station. The computer-assisted detection (CAD) program was subsequently applied to the posteroanterior DR images, and changes (if any) in diagnosis were recorded. For reference standard, a follow-up chest radiograph at least 6 months following the initial examination or a follow-up computed tomographic scan of the chest within 3 months was used to establish diagnostic accuracy.
Of 324 DR examinations, follow-up imaging according to our parameters was available for 214 patients (67%). Lung nodules were found and subsequently confirmed in 35 patients (10%) without CAD. Using CAD, nodules were found and subsequently confirmed in 51 patients (15%), improving sensitivity from 63.8% (95% confidence interval [CI], 0.49%-0.76%) to 92.7% (95% CI, 0.82%-0.98%) (P < .0001, McNemar). Nodules were subsequently proved to be malignant in five of the 16 additional cases (31%). False-positive readings increased from three to six cases; specificity decreased from 98.1% (95% CI, 0.95%-0.99%) to 96.2% (95% CI, 0.92%-0.98%) (not significant). There were 153 true-negative cases (71.4%).
This study suggests that the interpretation of chest radiographs for lung nodules can be improved using an automated CAD nodule detection system. This improvement in reader performance comes with a minimal number of false-positive interpretations.
Academic Radiology 05/2008; 15(5):571-5. · 1.69 Impact Factor
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Journal of cardiovascular computed tomography 02/2008; 2(1):64; author reply 64-5.
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Journal of cardiovascular computed tomography 01/2008; 1(3):168-9.
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ABSTRACT: The aim of this study was to assess mediastinal lymphatic drainage patterns from each pulmonary lobe using computed tomographic (CT) observations of calcified primary complex pulmonary histoplasmosis.
We assessed 400 CT studies of patients with primary complex histoplasmosis consisting of a single lobe pulmonary lesion and mediastinal nodal disease. We assessed the distribution of mediastinal nodal involvement depending on pulmonary lobes for the total number of involved nodes, the number with single-station involvement (which suggests the initial site of involvement), and the number with skip involvement which suggests direct drainage to the mediastinum.
The most commonly involved mediastinal nodal stations from the right upper lobe, left upper lobe, and left lower lobe were the right lower paratracheal node (97%, 74/76), the subaortic node (72%, 49/68), and the left pulmonary ligament node (61%, 66/108), respectively. These nodes were the most common site of skip involvement in each lobe. In the right lower lobe and middle lobe, the subcarinal node was most commonly involved: 62% (65/105) and 81% (35/43), respectively. By contrast, skip involvement was uncommon in the drainage to this node.
Our data show a predictable pattern of lobar lymphatic drainage to the mediastinum. This may have implications on the minimal N2 disease of non-small-cell lung cancer.
Radiation Medicine 11/2007; 25(8):393-401.
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ABSTRACT: Invasive coronary angiography is considered to be the gold standard for diagnosis and follow-up of coronary artery aneurysms, thrombosis and stenosis in patients with Kawasaki Disease. However, the availability of multi-detector CT coronary angiography provides a viable alternative as a non-invasive imaging modality for sequential follow-up of patients with Kawasaki disease. High quality multidetector CT angiography images of coronary arterial anatomy can be obtained after adequate heart rate control using beta blockers.
The International Journal of Cardiovascular Imaging 01/2007; 22(6):803-5. · 2.29 Impact Factor
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ABSTRACT: Delineation of the interlobar fissures on multiplanar reconstruction (MPR) images is useful to assess masses at the fissures for invasion into adjacent lobes. We performed this study to determine the appropriate MDCT protocol to visualize the interlobar fissures on sagittal MPR images.
For the phantom studies, radiographic film was used to replicate the interlobar fissures. For the clinical studies, we obtained MDCT scans of 130 patients with normal interlobar fissures. Visualization of the interlobar fissures on sagittal MPR was assessed using the following scanning parameters: scan collimations of 0.5, 1, 2, and 3 mm with helical pitches of 1 and 1.5 for the phantom studies; and scan collimations of 0.5, 1, 2, and 3 mm with a helical pitch of 1.5 and a scan collimation of 2 mm with a helical pitch of 1 for the clinical studies.
To visualize fissures as a sharp line, a 0.5- or 1-mm collimation was required for the major fissure and 0.5 mm for the minor fissure in the phantom studies. In the clinical studies, 0.5-mm-collimation MPR images depicted interlobar fissures as a sharp line in all cases. Fissures on MPR images using 1-, 2-, and 3-mm collimations appeared as a sharp line in 77.5-95.0%, 0-43.3%, and 0% of cases, respectively.
Volume data obtained using a 1-mm collimation are required to visualize all the interlobar fissures as a sharp line on sagittal MPR images except the minor fissure and superior portion of the right major fissure, for which a 0.5-mm collimation is required.
American Journal of Roentgenology 09/2006; 187(2):389-97. · 2.78 Impact Factor
