text: The Most Predictable Man in Baseball by Ben Clemens June 14, 2019 The Tampa Bay Rays are having a tremendous year so far, better than anyone could have expected. They're a half game out of first in the perennially difficult AL East, and that might be underselling how good they've been this year — their BaseRuns record is the best in baseball. How have they done it? Their pitching staff has been the best in baseball by a huge margin, posting a 3.02 ERA and a 3.34 FIP, both of which are miles better than second place. The hitting has been good, but pitching has the Rays playing like a championship contender. That pitching staff has been a many-headed monster this year, and Yonny Chirinos has been a key part of it. He's bounced back and forth between starting and following an opener (headlining?) over 75 innings of work, compiling a 2.88 ERA and 4.05 FIP in his second major league season. He was above average last year as well — a matching 3.51 ERA and FIP over nearly 90 innings. He sports a 21.5% strikeout rate and a sterling 4.9% walk rate. In short, Chirinos looks like a mid-rotation major league starter for the foreseeable future. What's truly amazing about him, however, is that he's doing that while being the most predictable pitcher in all of baseball. If you're behind in the count against Yonny Chirinos, it's going to be a long day for you. His splitter, which he only learned in 2017, is lights-out. It's been the third-most-valuable splitter in baseball this year, behind relievers Hector Neris and Kirby Yates. It generates truly video game numbers: a 45% whiff rate, 2.5 ground balls for every fly ball, and a .155 wOBA on plate appearances that end with a splitter. When Chirinos has the advantage, he's not shy about going to the split: he throws it 43% of the time, more than twice as often as his overall rate of splitters. No, if you want to beat Chirinos, you need to avoid the splitter. If you end up in a two-strike count, you'll probably wave at air before heading back to the bench. Get ahead in the count, however, and things change. Chirinos has an effective fastball, a 94-mph sinker with huge horizontal break that runs in on the hands of righties. Still, it's a fastball, not a world-destroying offspeed pitch. There's no question which offering you'd rather face. Why do I keep referencing the count when it comes to which version of Chirinos a batter will face? Well, consider this: when he's behind in the count, Chirinos throws 84% fastballs. He's not sinker-only, but he's close to it — he's thrown only two four-seam fastballs while down in the count all year. It's not quite accurate to say that Chirinos is a one-pitch pitcher when behind in the count, but it's close enough as a first approximation. That 84% fastball rate when behind in the count doesn't make Chirinos unique. Sean Doolittle has thrown only fastballs when behind in the count. Zack Britton is close behind — he's throwing 99% fastballs to get back into at-bats. Among pitchers who have thrown 100 pitches while behind in the count, Chirinos has the 21st-highest fastball rate. The top two places on the list aren't all that illustrative. Maybe Doolittle throws 100% fastballs when he's behind, but he throws 92% fastballs overall. No matter the count, the game is the same: he's throwing a fastball, and the hitter needs to find a way to deal with that fastball. Chirinos, on the other hand, isn't a fastball-only pitcher, or even someone who throws a ton of fastballs. His 57.1% fastball rate is barely in the top third of all qualified starters this year. Not only does he throw more than 20% splitters, but he has a cromulent slider too. He's a true three-pitch pitcher — at least, in his overall stats. To get a sense of how bifurcated Chirinos's pitch selection is, think of it this way: When he's behind in the count, Chirinos throws the 11th-most fastballs in baseball. When he's ahead in the count, he throws the 25th-fewest (out of 282 pitchers). No pitcher in baseball has a larger gap between fastball rates when ahead and behind. I already mentioned that Chirinos throws 84.3% fastballs when he's behind. When he's ahead, that number dips to 33.7%. That 50.6% gap is the most in baseball by a lot. To borrow an old Jeff Sullivan descriptor, the gap between Chirinos and second-place Seranthony Dominguez is the same as the gap between second and 10th place. Here's that list: Behind? Throw a Fastball Player FB% Increase When Behind Yonny Chirinos 50.6% Seranthony Dominguez 43.7% Tyler Glasnow 42.2% Ryne Stanek 41.3% Victor Alcantara 40.2% Brad Hand 39.3% Spencer Turnbull 38.9% German Marquez 38.6% Trevor Bauer 36.7% Brandon Kintzler 36.4% Now, pitch mix isn't as easy as just saying you should be unpredictable and throw every pitch in equal proportion in any count. The rule of thumb that you should throw fastballs when behind and secondary pitches when ahead is logical: balls cost you more when you're already down in the count. What the batter expects matters too — fastballs work a lot better when batters aren't expecting them. There's no way around the fact that no one rule of thumb works for every pitcher. Hitter expectations, command, and type of secondary pitches all affect the optimal mix, and there's no guarantee it's stationary. Still, 50% sounds like a lot to increase your fastball rate by. When I looked into Trevor Bauer's fastballing ways earlier this year, I came up with a method of modeling that I'm pretty happy with for looking at whether pitch selection in a given count makes sense. Looking directly at results runs into sample size issues — a single extra-base hit against a Chirinos off-speed pitch would have an outsize effect given their rarity in some counts. Instead, the idea is to look at some basic outcomes of a pitch — called strikes, balls, swinging strikes, foul balls, and balls in play. There's some argument that fouls aren't stable enough to include in analysis like this, and I'm honestly not sure which side of that argument I come down on: foul ball rates are certainly volatile, but there's probably some skill there. In the following analysis, I'm treating foul balls as in the pitcher's control, but if you want to regress those to league average by pitch type, I could totally see the logic in that as well. Swinging strikes, called strikes, and balls are all pretty straightforward — pitchers have a ton of agency in all three. The last thing we need to work out in terms of what value Chirinos is getting from throwing so many fastballs in fastball counts is the value of batted balls. When doing this analysis with more established pitchers, I like to separate out in-zone contact and out-of-zone contact. After all, making contact with a wipeout slider just before it hits the dirt is a lot different than hitting a slider that catches the middle of the strike zone. In Chirinos' case, however, there simply isn't enough data to split things out that way. Opponents have only put 27 out-of-zone splitters into play in his career, for example. The sample size is just too small. I considered a few options (normalize Chirinos' in-zone results by some constant I figured out from all splitters, try to build a model that uses a few factors about pitchers to predict out-of-zone rates, plus some not-very-well-thought-out other attempts), but I settled on a more straightforward approach: ignoring in-zone versus out-of-zone and just taking the xwOBA on contact of every ball in play Chirinos has allowed on each pitch. With more data, I might try to split things out more (such as looking at fastball contact in specific counts or situations), but the data is a bit too sparse to do that until he pitches more. Is it perfect? Definitely not. Does it get the job done? I think so. On to the results! Chirinos throws an absolute ton of strikes when he's down in the count. His fastball is in the zone 67% of the time — he's simply not willing to give up a walk. Batters are no dopes, though — they swing at 75% of those in-zone fastballs. Put it together, and sprinkle in a Markov chain-based accounting of the value of strikes, balls, and fouls, and here's what it looks like: Change in wOBA, Fastball, Down in Count Result Change(wOBA) Frequency Ball 0.136 24.4% Strike -0.099 24.9% Foul -0.064 22.2% In Play 0.053 28.5% Total 0.010 100.0% Not great, Yonny. Throwing a fastball leads to better outcomes for batters by 10 points of wOBA. I can't stress enough that this is only a toy, and that there are huge margins of error on any of my calculations. Still, it seems like the complete lack of whiffs on fastballs isn't helping. Let's look at the same data for the splitter: Change in wOBA, Splitter, Down in Count Result Change(wOBA) Frequency Ball 0.136 27.3% Strike -0.099 45.5% Foul -0.064 4.5% In Play -0.004 22.7% Total -0.012 100.0% Now if the fastball sample size was small, this is microscopic. I don't have a ton of faith in basically any number here. Still, it seems likely that when Chirinos throws a splitter, he's getting value. Batters take a ton of strikes (they barely swing at half of his in-zone splitters, and he's been good at spotting it in the zone when he's down in the count) and whiff a lot when they do swing. Essentially, they're underprepared for the pitch. Last but not least, let's look at sliders. That's another way Chirinos could go if he wanted to throw fewer fastballs in hitters' counts. If his splitter is a glimpse into how much better Chirinos could be, the slider is a peek at the other side. He hasn't been as good, thus far in his career, at locating the slider in the zone, and that greatly saps its value. Change in wOBA, Slider, Down in Count Result Change(wOBA) Frequency Ball 0.136 34.4% Strike -0.099 26.7% Foul -0.064 16.7% In Play 0.008 22.2% Total 0.012 100.0% So what do these results tell us? Basically, it's hard to say! Chirinos is doing himself no favors by throwing so many fastballs. With very few strikes and foul balls, he gets few strikeouts, ending up with a ton of balls in play. It shows in his stats thus far — splits are always a little dicey from a sample size perspective, but Chirinos has struck out only 12.5% of batters after a 1-0 count for his career, as compared to 18% for the league as a whole. For completeness' sake, here are the pitch values when Chirinos is ahead in the count. If there's anything interesting here, it's that one piece of baseball wisdom absolutely checks out: if you, the pitcher, are ahead in the count, you'd prefer to throw a ball rather than have your opponent put the ball in play. Change in wOBA, Fastball, Ahead in Count Result Change(wOBA) Frequency Ball 0.034 40.1% Strike -0.141 18.7% Foul -0.033 20.1% In Play 0.187 21.1% Total 0.020 100.0% Change in wOBA, Splitter, Ahead in Count Result Change(wOBA) Frequency Ball 0.034 42.0% Strike -0.141 26.8% Foul -0.033 14.8% In Play 0.130 16.3% Total -0.007 100.0% Change in wOBA, Slider, Ahead in Count Result Change(wOBA) Frequency Ball 0.034 31.9% Strike -0.141 25.8% Foul -0.033 20.3% In Play 0.142 22.0% Total -0.001 100.0% Do I think this analysis is groundbreaking and that I've solved something previously unknown about Yonny Chirinos's game? Honestly, no. The Rays are really good at analyzing baseball. They've no doubt thought about this, and they're better at massaging the numbers to get useful data. I think it's notable though. Yonny Chirinos throws way more fastballs when he's behind, and maybe he throws a few too many. When he's ahead, however, he throws an entire mountain of splitters, and he should maybe throw even more. Not enough analysis has been done about how you should change your pitching style based on count. It's an interesting baseball problem, an interesting game theory problem, and really just a tremendous mind game. The case of Yonny Chirinos provides an interesting window into what might make sense. Throwing more fastballs when you need strikes isn't necessarily bad, and it isn't necessarily good. It's contextual, to the point where we can look at an extreme outlier and not really know whether being so extreme is good or bad. The next time I watch Chirinos pitch, I'm going to be watching every 1-0 pitch intently, waiting to see yet another sinker and yet another batter expecting a sinker. Even better, maybe I'll see a splitter! Rarity is beautiful, after all.


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Wages higher in Ontario's public sector than private sector, says Fraser Institute
by Canadian Manufacturing.com Staff
Recent study by think-tank finds that government employees in Ontario are enjoying higher wages and benefits than their private sector counterparts
TORONTO—Government employees in Ontario get higher wages, on average, than comparable workers in the private sector, according to a new study by the Fraser Institute, a right-leaning Canadian public policy think-tank.
"Queen's Park and the federal government, which has a lot of employees in Ontario, are both struggling financially. Scrutinizing public sector compensation would be a good first step to address their fiscal challenges without affecting services," said Charles Lammam, director of fiscal studies at the Fraser Institute.
The study finds that federal, provincial, and municipal government employees in Ontario received 13.4 per cent higher wages, on average, than comparable workers in the private sector in 2015.
The study also finds that government workers in Ontario enjoy more generous benefits.
- Pensions: 79.7 per cent of government employees are covered by guaranteed benefits, compared to just 11.4 per cent in the private sector
- Early retirement: Government employees retire 1.4 years earlier, on average, than the province's private-sector workers
- Personal leave: Government employees are absent from their jobs for personal reasons 60 per cent more often than private-sector workers, 10.9 days compared to 6.8 days
- Job security: Government employees enjoy much more job security, and are six times less likely to experience job loss than private-sector workers, 0.5 per cent compared to 3.2 per cent
"The Ontario government, in particular, is struggling with persistent deficits and soaring debt, and bringing public-sector compensation in line with the private sector would help Queen's Park better control spending," said Ben Eisen, director of the Ontario Prosperity Initiative at the Fraser Institute.
"It's important that governments provide competitive compensation to attract qualified employees, but the fact is wages and benefits in the government sector are out of step with the private sector," Lammam said.
According to the Fraser Institute, public-sector compensation accounts for about half of annual provincial government program spending.
The full study, Comparing Government and Private Sector Compensation in Ontario, can be found here.
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subset: commoncrawl


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Tagged With "Aligning Systems for Health"
Blog Post
A Critical Assessment of the Adverse Childhood Experiences Study at 20 Years [sciencedirect.com]
This year marks the 20th anniversary of publication in this journal of the first of many articles on the adverse childhood experiences (ACEs) research by Drs. Felitti, Anda, and colleagues. As we celebrate the impact of this seminal research, it is also imperative to assess critically its serious limitations: an unrepresentative study population and narrow operationalization of childhood adversity lead to undercounting adverse experiences and misrepresenting their social distribution.
Blog Post
ACE Surveillance Study of Teachers and Administrators in Public and Private Schools in Southwest Nigeria, West Africa
Note: These findings were presented at the Child Trauma Conference in Lagos on October 25-26, 2019. Rationale: Many children today live with layers of stress both subtle and overt which in this report are collectively referred to as Adverse Childhood Experiences (ACEs). Specifically, these ACEs are physical, emotional and sexual abuse; physical and emotional neglect; household dysfunction and domestic violence as well as community violence. The children have a life marked by chaos,...
Blog Post
ACEs Connection's Inclusion Tool makes sure nobody's left out
We developed ACEs Connection's Diversity, Equity & Inclusion Tool — called the Inclusion Tool, for short — to ensure that ACEs initiatives across the world focus on being inclusive when forming a steering committee, recruiting leaders, providing education about ACEs science, recruiting members, or providing resources and services within their communities. The more inclusive your ACEs initiative is, the more diverse it will be, giving your initiative a real shot at achieving equity and...
Blog Post
Aligning Systems for Health: 2019 Call for Proposals [rwjf.org]
By Robert Wood Johnson Foundation, November 1, 2019 Required Components Aligning Systems for Health will explore the degree to which health equity is impacted or results from current models of collaboration incorporating health care, public health, and social services. Gaps in health are large, persistent and increasing, and RWJF is committed to a system that meets people's goals and needs and addresses these gaps that many populations face. Studies should include a focus on health equity by...
Blog Post
Dissecting Racial Bias in an Algorithm Used to Manage the Health of Populations [science.sciencemag.org]
By Ziad Obermeyer, Brian Powers, Christine Vogeli, and Sendhil Mullainathan, Science, October 25, 2019 Racial bias in health algorithms The U.S. health care system uses commercial algorithms to guide health decisions. Obermeyer et al. find evidence of racial bias in one widely used algorithm, such that Black patients assigned the same level of risk by the algorithm are sicker than White patients (see the Perspective by Benjamin). The authors estimated that this racial bias reduces the number...
Blog Post
Family First Scholarships for 21st Annual Families and Fathers Conference
21st Annual Families and Fathers National Conference February 24-27, 2020 Hilton Los Angeles Airport 5711 West Century Boulevard Los Angeles, California 90045 I am honored to announce The Family First Scholarship supported by the Annie E. Casey Foundation as a Title Sponsor and State of California First 5 as a Co-Sponsor for the 21 st Annual Families and Fathers Conference, Next Level 2020! the terms "putting family first" and "it takes a village to raise a child" parallels with why we have...
Blog Post
Family Resilience And Connection Promote Flourishing Among US Children, Even Amid Adversity [healthaffairs.org]
Flourishing and its predictors and links to health outcomes are well documented in adults, including among those facing adversities. Less is known about flourishing and its correlates among children, especially those who face circumstances such as adverse childhood experiences (ACEs), chronic illness, or poverty. Studies show that flourishing is distinct from an absence of physical or mental illness and other adversities; that flourishing can and does exist amid these circumstances; and that...
Blog Post
Sending your boy to preschool is great for your grandson, new research shows [hechingerreport.org]
Nearly 60 years ago, a handful of 3- and 4-year-old black children living in a small city outside of Detroit attended a preschool program known as the Perry Preschool Project. The children were part of an experiment to see if a high-quality educational experience in a child's early years could raise IQ scores. Kids' IQ scores went up initially, but soon evened out with those of their peers. The same thing has happened more recently with the standardized test scores of children who attend...
Blog Post
Supporting Older Trauma Survivors as They Heal Their Pasts, Grow Their Futures
Members of The Living Well Theater perform at the Good Food for All Conference at the Free Library/Parkway Central Library. Photo courtesy of Marie-Monique Marthol. ________________________________ Marie-Monique Marthol handed out the cards to older adults at meetings of her local civic association. With the pastor's permission, she left some at a neighborhood church. She stacked them in restaurants, community centers and even at the laundromat. On the front, the cards read, "Time never runs...
Blog Post
The Brain Change Summit, A FREE Online Event (Now through May 2nd)
I want to be sure you are all aware of this opportunity. The Brain Change Summit is a FREE 10-day online event. It's currently underway and the speakers have been really outstanding. For registration and further details: https://www.soundstrue.com/store/brain-change-summit/free-access#a_aid=5c82ab8fc7797&a_bid=48584946 I'll be speaking on Calming the Fear-Driven Brain on April 30 at 5 pm PT / 8 pm ET. Once you've registered, you will be able to watch the speakers here:...
Blog Post
The First Five Years Matters: Quality of Early Relationships determines Lifelong Health
Quality of Early Relationships determines Lifelong Health The first relationship—usually this is between the mother and her infant—has an enduring impact on all later stages of human development. This relationship which occurs has been described by Bowlby's attachment theory, which at its core, is about how the mother helps the infant regulate emotion. The mother-infant attachment communications are essential because they directly affect the development of the brain. Dr. Allan Schore, the...
Blog Post
Trauma-Informed Social Justice: Q&A with Dr. Bukuloa Ogunkua
Cissy's Note: I work with people who challenge systems and policies, who reform or start non-profits, and who see hope and promise where others see despair or destruction. While some folks shake their heads or shrug indifferently in the face of injustice and suffering, others organize, mobilize, and channel their time and energy towards making a change. Maybe a physician hosts an annual conference bringing trauma-informed approaches to medical practice. Perhaps a woman shares ACEs 101...
Blog Post
West Africa ACEs CONNECTION: Chasing solutions for own ACE Score
Even though I have excelled in practically all endeavors that I set out to do and have succeeded in new learning, I continued to have flash backs of certain events from my past and residual anger on certain things. I was first introduced to Trauma theory when I was working in an Outpatient clinic for Men in 2001. The Trauma Recovery Empowerment Model TREM was the philosophy practiced in conjunction with Boston model of psychiatric rehabilitation at the clinic. The concept of recovery made...
Blog Post
What You Need to Know About Drugs, Drinking and the Teenage Brain
Adolescence awakens new emotions, social experiences and physical energy for many people. It's often a time when young people try new things, make new friends, depend less on parents, and live more passionately. But as an adult, your role is still important. You can have a positive impact on helping your loved ones avoid the dangers of teen substance use. Adolescence is also a time when some explore alcohol or drugs (such as heroin, cocaine, marijuana, and prescription medicine, among other...
Blog Post
Why Is the Pandemic Killing So Many Black Americans [podcasts.apple.com]
By The Daily, The New York Times, May 20, 2020 Some have called the pandemic "the great equalizer." But the coronavirus is killing black Americans at staggeringly higher rates than white Americans. Today, we explore why. Guest: Linda Villarosa, a writer for The New York Times Magazine covering racial health disparities, who spoke to Nicole Charles in New Orleans, La. about the death of her husband, Cornell Charles, known as Dickey. He was 51. For more information on today's episode, visit...
Calendar Event
1st Annual Trauma Conference, Lagos Nigeria
Blog Post
SACRAMENTO – The Office of the California Surgeon General today released the first California Surgeon General's Report - Roadmap for Resilience: The California Surgeon General's Report on Adverse Childhood Experiences, Toxic Stress, and Health. The report serves as a blueprint for how communities, states, and nations can recognize and effectively address Adverse Childhood Experiences (ACEs) and toxic stress as a root cause to some of the most harmful, persistent, and expensive societal and...
Blog Post
Trauma-Informed Education: Suburbancares Partners with Public, Parochial and Private Schools in Lagos State, Nigeria to Build Trauma-Informed Community
Suburban Healthcare Initiative (DBA, Suburbancares) has provided several training sessions and workshops in child trauma and child behavioral health awareness in several States in south-west Nigeria since 2009. The awareness campaign was started in response to the invitation by Mrs. Folasade Adefisayo who was Principal of the Corona Secondary School, Agbara at the time. Dr. Bukola Ogunkua, CEO Suburbancares and a child trauma expert with the American Academy of Experts in Traumatic Stress...
Ada Claus
Dr. Bukola Ogunkua
Anita Shankar
Onibudo Glory
Nana Ama Adom-Boakye
Drew Factor
Teniola Okun
Blog Post
FREE WEBINAR - The Impact of Mind Matters: Preliminary Evidence of Effectiveness in a Community-Based Sample
Becky Antle, Ph.D., Professor of Social Work and esteemed University Scholar at the University of Louisville, won The Dibble Institute's national competition to evaluate Mind Matters: Overcoming Adversity and Building Resilience in 2019. As a result, Dr. Antle and her colleagues have conducted a randomized controlled trial to examine the impact of Mind Matters on a host of outcomes related to trauma symptoms, emotional regulation, coping and resiliency, and interpersonal skills for at-risk...
Blog Post
Me & My Emotions: A New, Free Resource for Teens
The pandemic has had a lasting effect on youth mental health. Moved by a desire to reduce youth's toxic stress and increase their resilience, The Dibble Institute, in partnership with a team of students and alumni from ArtCenter College of Design and author Carolyn Curtis, PhD, is releasing Me & My Emotions —a new, free adaptation of our beloved Mind Matters Curriculum. The mobile-friendly Me & My Emotions website features engaging graphics and bite-sized lessons teens can access and...
Christine Cissy White
Blog Post
48-Hour Historical Trauma Specialist Certification Program- COHORT 1 & 2
NOT TOO LATE FOR COHORT 1!! Also registering for COHORT 2!! New!! 48-HOUR HISTORICAL TRAUMA SPECIALIST CERTIFICATION in collaboration with THE INTERNATIONAL HISTORICAL TRAUMA ASSOCIATION We are the only entity offering a comprehensive, 48-hour Historical Trauma Specialist Certification Program. The Program is broken into 6 levels and is built on a foundation of BIPOC cultures and neurobiology. It is taught from a multicultural perspective, injecting traditions and ideology from various...
Blog Post
48-Hour Historical Trauma Specialist Certification Program- COHORT 1 & 2
New!! 48-HOUR HISTORICAL TRAUMA SPECIALIST CERTIFICATION in collaboration with THE INTERNATIONAL HISTORICAL TRAUMA ASSOCIATION We are the only entity offering a comprehensive, 48-hour Historical Trauma Specialist Certification Program. The Program is broken into 6 levels and is built on a foundation of BIPOC cultures and neurobiology. It is taught from a multicultural perspective, injecting traditions and ideology from various cultures from around the world. In this inclusive study we rely...


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Asif, Military Exam expert at JobTestPrep.Have a question? Contact me at: email@example.com
The PiCAT is an un-proctored and un-timed version of the ASVAB test. Upon passing the PiCAT you will take a 30-minute proctored PiCAT Verification Test to ensure you did not cheat. Failing the verification will result in taking the ASVAB. The PiCAT contains ten sections with 10-20 questions in each segment.
Please note that to take the PiCAT you must be a high school graduate.
Now that we have provided a broad overview of the test, let's get into the specifics.
The PiCAT is the sister test to the full ASVAB test; as long as you pass both the full version PiCAT and the verification afterwards, it will be considered the ASVAB test equivalent. However, please note, that the Verification is designed to catch cheaters. Therefore, if its results differ from the un-proctored/un-timed test, you will be forced to take the full three hour and proctored-timed ASVAB.
The verification test is taken at a military entrance processing station (MEPS) or a military entrance test (MET) site.
As mentioned above, you can technically cheat, but cheating on the ASVAB test will be of little help when taking the 30-minute Verification Test. Make sure you thoroughly prepare.
Unlike the ASVAB test, which can be retaken after a month and coordinating with your local recruiting officer, the PiCAT demands a minimum two year wait period. This fact, should again highlight the supreme importance of using an accurate and methodological system of preparation.
Well, the answer is complicated because every branch of the military has its unique qualification measure. Furthermore, the score measures can be changed at any given notice. Minimum passing scores will vary by a branch from 31-40; however, it is wise to aim for a minimum of 50.
There are several pros and cons to taking the PiCAT vs. the traditional ASVAB. Don't worry. We will get the cons in the next section.
Now that we have presented a general overview of the test, let's review some of the differences between PiCAT and the ASVAB.
In terms of the subjects and the number of questions, they are identical. However, there are several technicalities that can make the PiCAT much more difficult.
Here are some sample questions for several of the PiCAT categories straight from our ASVAB practice tests. These are all multiple choice and timed, as stated.
Mathematical Knowledge Sample Question
A container has internal dimensions of 150 cm by 60 cm by 50 cm. Each oil barrel's dimensions are 100 cm by 50 cm by 20 cm. How many barrels can one pour into the container?
Postpone means the same as-
You will directly convert to taking the full 3-hour long ASVAB.
While we do not know exactly which questions, it will only be 30 questions that you got right on the PiCAT. The 20-minute test will be proctored.
Well, in 90-95% of cases this is the case, however, the system automatically fails 5%-10% of test-takers, no matter how well they did on the PiCAT or the Verification. This is perhaps the greatest risk of taking the PiCAT as opposed to the ASVAB.
One of the purposes of the Verification is to ensure that you not only get the answer right, but that you followed the same process as you did on the full-length test. Don't try to look smarter, just copy and paste. If not, you will be taking the full ASVAB.
The Confirmation test is for those who took the ASVAB test and failed, then took it a second time, and got at least 20 points higher. However, the test is similar in principle in that it ensures you did not cheat or just guess and got lucky.
If you have any specific questions related to your recruitment location, please contact your local military recruiter.


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Delineation of tumour boundaries is important for quantification of [18F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) studies and for definition of biological target volumes in radiotherapy. Several (semi-)automatic tumour delineation methods have been proposed, but these methods differ substantially in estimating tumour volume and their performance may be affected by imaging parameters. The main purpose of this study was to explore the performance dependence of various (semi-)automatic tumour delineation methods on different imaging parameters, i.e. reconstruction parameters, noise levels and tumour characteristics, and thereby the need for standardization or inter-institute calibration.
Six different types of delineation methods were evaluated by assessing accuracy and precision in estimating tumour volume from simulations and phantom experiments. The evaluated conditions were various tumour sizes, iterative reconstruction algorithm settings and image filtering, tumour to background ratios (TBR), noise levels and region growing initializations.
The accuracy of all automatic delineation methods was influenced when imaging parameters were varied. The performance of all tumour delineation methods depends on variation of TBR, image resolution and image noise level, and to a lesser extent on number of iterations during image reconstruction or the initialization method of the region generation. For sphere sizes larger than 20 mm diameter a contrast-oriented method provided the most accurate results, on average, over all simulated conditions. For threshold-based methods the accuracy of tumour delineation improved after image denoising/filtering.
The accuracy and precision of all studied tumour delineation methods was affected by physiological and imaging parameters. The latter illustrates the need for optimizing imaging parameters and/or for careful calibration and optimization of delineation methods.
Quantitative analysis of oncological positron emission tomography (PET) studies, e.g. for response assessment, target definition for radiotherapy and glycolytic tumour volume measurements, usually involves delineation of tumour boundaries and several tumour segmentation methods have been reported [1–3]. Accurate and reproducible delineation of tumours may enhance accuracy and precision of quantitative PET studies required for response monitoring purposes. In addition, there is growing interest in the use of PET for tumour delineation in radiotherapy [4, 5]. In this case, accurate tumour delineation is extremely important in order to focus the dose on viable tumour tissue, thereby sparing surrounding normal tissue and allowing a higher radiation dose to the target region.
[18F]Fluoro-2-deoxy-D-glucose (FDG) is most widely used for detection, staging and treatment monitoring as well as for determining boundaries of the target volume in radiotherapy [6–9]. [18F]FDG tumour delineation methods range from visual (manual) approaches to (semi-)automatic algorithms [1–3, 10]. These studies have compared tumour contours obtained with [18F]FDG PET, CT, MRI and/or pathologic data, reporting substantially different tumour volumes. Furthermore, manual delineation methods strongly depend on the experience of the physician and on the specific contouring protocol used [11]. This may lead to high variation in [18F]FDG-based gross tumour volume (GTV) delineation. There is general consensus that (semi-)automatic delineation methods may reduce this variability.
Numerous factors could affect accuracy of PET quantification, i.e. scanner or image resolution, scanner type and settings of image reconstruction algorithms, image filtering, level of image noise, and tumour characteristics [12]. To date, however, evaluation of the various factors affecting performance of tumour delineation or volume of interest (VOI) methods is still limited. Consequently, VOI methods are often being used without proper validation or optimization for the specific scanner at a particular site [13]. Therefore, the primary objective of this study was to explore the performance of various commonly used (semi-)automatic VOI methods depending on imaging parameters, i.e. image reconstruction settings and filtering, image noise levels, and tumour characteristics. The secondary objective is thus to demonstrate the potentially large errors that may occur when using these methods in a non-calibrated or non-standardized manner and to illustrate the need for inter-institute calibration when using PET for the assessment of 'metabolic' tumour volumes.
Materials and methods
Simulation experiments
The same procedures for performing simulations as described in [14] were used. The method is based on a computer-generated image of the thorax that was derived from a summed 2-D dynamic [18F]FDG scan of a typical patient (i.e. all image data collected from 15 to 60 min post-injection are summed into a single image). Next, spheres of various sizes (10, 20, 30, 40 and 50 mm diameter), simulating tumours, were placed in both lung and mediastinum, applying tumour to (lung) background ratios (TBR) of 4, 8 and 12. These images were then forward-projected using a rotation-based forward projector to generate sinograms. Poisson noise was then applied to these sinograms, such that reconstructed images showed voxel variances of ~22 and ~47% coefficients of variation (COV) in homogeneous background areas (liver or mediastinum). The transmission scan obtained during the same clinical patient study was used to incorporate the effects of photon attenuation. These computer-generated sinograms were reconstructed using attenuation-weighted ordered subsets expectation maximization (OSEM) with 16 subsets and 1, 2, 4 or 6 iterations. An image matrix size of 256 × 256 was used, corresponding to a voxel size of 2.56 × 2.56 × 2.56 mm3. For each combination of tumour size, resolution, TBR, noise level and number of iterations, 100 reconstructed images were generated from 100 'noisy' realizations (i.e. Poisson noise was applied 100 times) of a sinogram to evaluate both accuracy and precision of each volumetric tumour delineation method. Reconstructed images were used without and with additional smoothing using a 3-D isotropic Gaussian kernel of 5 and 7 mm full-width at half-maximum (FWHM), thereby reducing both resolution and image noise. Finally, all images (either with or without the Gaussian filtering) were evaluated with and without use of an edge-preserving bilateral filter for further denoising in order to reduce statistical noise in the images. This filter consists of a Gaussian smoothing filter (10 mm FWHM) which is multiplied by a second Gaussian function that penalizes the filter based on differences in voxel intensity or standardized uptake value (SUV) between neighbouring voxels (sigma: 1.5).The algorithm is implemented using two iterations, exactly as described in [3].
Phantom experiments
To further evaluate the various volume delineation methods, a National Electrical Manufacturers Association (NEMA) image quality phantom was used, containing six spheres with volumes ranging from 0.53 to 26.52 ml (having diameters of 10, 13, 17, 22, 28 and 37 mm, respectively). The background compartment was filled with an [18F]FDG solution of 5 kBq/ml and spheres were filled with an [18F]FDG solution of 25 or 45 kBq/ml (simulating a TBR of approximately 5 or 9, respectively).
The phantom was first scanned using an ECAT EXACT HR+ scanner (Siemens/CTI, Knoxville, TN, USA) [15]. The PET study started with a 10-min transmission scan, after which an emission scan was acquired in 3-D mode. This scan consisted of 20 frames, each with 300 kilocounts, corresponding to the average number of counts observed in 3 min of a typical oncological [18F]FDG study. Data were reconstructed using OSEM with 2 iterations and 16 subsets. Additional smoothing was applied using a 5 mm FWHM Gaussian filter. Resulting images consisted of an image matrix size of 256 × 256 × 63 and a voxel size of 2.57 × 2.57 × 2.43 mm3.
The same phantom was also scanned on a GEMINI TF PET/CT system (Philips Healthcare, Highland Heights, Ohio, USA) [16], again with 20 frames and the same counts (300 kilocounts) for all frames. Data were reconstructed using a time-of-flight (TOF) reconstruction algorithm (blob-based OSEM TOF) using standard reconstruction settings, as these cannot easily be modified by the user. Resulting images consisted of an image matrix size of 144 × 144 × 44 and a voxel size of 4.00 × 4.00 × 4.00 mm3.
After reconstruction, the same edge-preserving bilateral filter as applied in the simulations was used in order to reduce noise in the images from both the HR+ and GEMINI TF phantom experiments.
Data analysis
Six different types of (semi-)automatic VOI methods were used to determine tumour volumes in the PET images:
Fixed threshold range of 41–70% of maximum voxel value within tumour (VOI41, VOI50, VOI70). This method applies a threshold based on a percentage (i.e. here 41–70%) of the maximum voxel intensity within the tumour [14]. Next this threshold is used to delineate the tumour.
Adaptive threshold range of 41–70% of maximum voxel value within tumour (VOIA41, VOIA50, VOIA70). This method is similar to the fixed threshold method, except that it adapts the threshold relative to the local average background, thereby correcting for the contrast between tumour and local background [14]. For example, the A50 contour value corresponds to a value at 50% of the sum of the maximum voxel value and the local background value. The latter value is derived from 'background' voxels that are identified as those voxels located on a single voxel thick shell at 2.5 cm from the edge of a 70% of maximum pixel value isocontour, excluding all voxels with an SUV larger than 2.5.
Contrast-oriented method (VOISchaefer). This algorithm [1] uses a correction by measuring the mean of 70% SUVmax and background activity for various sphere sizes. Regression coefficients are calculated, which represent the relationship between optimal threshold and image contrast for various sphere sizes. This threshold equation is given by:$$ Threshol{d_{{optimal}}} = A \times meanSU{V_{{70\% }}} + B \times Background $$
where A and B were fitted using phantom studies [1]. In general, different values are applied for sphere diameters smaller and larger than 3 cm diameter. In the present paper, we calibrated this method, i.e. we determined the A and B values that are specific for each of the simulated image resolutions and for both PET systems included in this study.
Background-subtracted relative threshold level (RTL) method (VOIRTL). This method is an iterative method based on a convolution of the point spread function (PSF) that takes into account the differences between various sphere sizes and the scanner resolution [2]. The optimal RTL depends on diameter size, but not on TBR. For the phantom experiments we used the PSF measured on each scanner and for the simulations we used the simulated image resolutions.
Gradient-based watershed segmentation method (GradWT). This method uses two steps before calculating the VOI. First, this method calculates a gradient image on which one 'seed' is placed in the tumour and another one in the background. Next, a watershed (WT) algorithm [3] is used to grow the seeds in the gradient basins, thereby creating boundaries on the gradient edges. In our presentation, the watershed continues to grow the gradient basins until all voxels are either classified as 'tumour' or 'non-tumour (background)'. The voxel will be assigned to tumour in case two watersheds are competing for the same voxel, i.e. 'border' voxels are assigned as tumour.
Absolute SUV (SUV2.5). Normalized (SUV) voxel intensities at a chosen absolute threshold are used to delineate tumour. An SUV of 2.5 was used as it might properly differentiate between benign and malignant lesions and might also be used for GTV delineation [17]. However, this threshold of 2.5 remains arbitrary.
For all methods the maximum intensity (i.e. maximum voxel value) within a sphere was identified. In addition, the maximum voxel value was obtained by applying a cross-shaped pattern or VOI that could be less sensitive to noise. This method searches for the region with the (local) average maximum intensity, based on the average of seven neighbouring voxels, which was then used as maximum or 'peak' value.
All delineation methods were evaluated by assessing accuracy (bias) and precision (standard deviation, SD) of estimating the volume. Per cent bias was defined as \( (\frac{{Volum{e_{{measured}}}}}{{Volum{e_{{true}}}}} - 1) \times 100\% \). Note that bias may be negative, indicating underestimation of the sphere volume. Accuracy and precision of the estimated volumes were calculated using averages and SD over 100 simulations or over 20 phantom images. In addition, for the simulations, the mean of absolute differences between percentage bias of the 30-mm sphere and percentage bias of other sphere sizes (i.e. 20, 40 and 50 mm) was reported to assess the variation in bias across the different tumour sizes.
Simulation experiment: general results
Tumour boundaries from automatic delineation methods were affected by the choice of various settings, i.e. sphere size, TBR, reconstruction settings, image resolution and noise levels. Figure 1 shows bias as function of tumour size for simulation data in both lung (Fig. 1a) and mediastinum (Fig. 1b). Data presented in Fig. 1 were generated using a TBR of 8 and simulated sinograms were reconstructed using OSEM with 4 iterations, 16 subsets and 5 mm FWHM Gaussian post-smoothing. Most methods showed an underestimation of tumour volume for both regions (i.e. approximately −5 to −25% for the largest sphere), with the exception of GradWT that showed an overestimation (>23% for the 20- to 50-mm diameter spheres in both regions). In the case of the smallest sphere, none of the methods could define tumour volume accurately, especially in the mediastinum (with biases up to 45% for VOIRTL). VOISchaefer, however, was able to accurately derive tumour volume in most cases within about 10%. Only the five best performing methods (i.e. GradWT, VOI41, VOIA41, VOIRTL and VOISchaefer), i.e. absolute bias <15% for spheres ≥20 mm in the lung, were evaluated further for various image characteristics.
In general, both HR+ (Fig. 2a, b) and GEMINI TF (Fig. 2c, d) phantom studies showed similar trends as in simulations, indicating that simulations are suitable for evaluating the impact of image characteristics on performance of VOI methods. As simulations are more flexible in generating different data sets with multiple noisy replicates [14], the effects of varying imaging parameters and image characteristics were assessed using simulation data only.
Simulation experiment: effects of reconstruction settings
There were only minor differences when image reconstruction settings were varied. In general, each delineation method showed small differences in bias (<3% for 20- to 50-mm diameter spheres) when varying the numbers of iterations.
Simulation experiment: effects of TBR
The accuracy of tumour delineation methods depends on TBR as indicated in Table 1 (Supplementary Fig. 1). For most methods (GradWT, VOI41, VOIA41, VOIRTL and VOISchaefer) bias increased when TBR decreased with the largest differences in bias between TBR values of 4 and 8. Only GradWT showed a large increase in the mean of absolute difference in bias amongst various tumour sizes when TBR decreased from 8 to 4 (4.6%, other methods: <0.6%). Bias improved by only ~3% when TBR was increased from 8 to 12.
Simulation experiment: effects of spatial resolution
Large differences were observed between smoothed and non-smoothed images for all methods (Table 1 and Supplementary Fig. 2). Smoothing the images improved the bias in delineated tumour volumes as obtained with VOI41, VOIA41, VOIRTL, GradWT and VOISchaefer to at most about 10% for all, except the smallest sphere sizes. For GradWT the mean of absolute difference amongst various tumour sizes improved when smoothing was applied. Large differences were observed between non-smoothed computer-generated images of high noise levels and smoothed images for all VOI methods.
Simulation experiment: effects of noise level, image filtering and region growing initialization
Slightly better accuracy for percentage threshold methods was observed as well as a slight improvement in SD of about 1% when using a cross-shaped pattern instead of the maximum voxel value (Table 1). Bias obtained with VOI41 and VOIA41 improved with approximately 5% for each sphere size when compared to using a single voxel maximum value.
Use of the bilateral filter improved bias by approximately 10% for VOI41, VOIA41 and VOIRTL. The resulting measured volume was close to the actual volume for spheres ≥20 mm (bias <5%). In contrast, GradWT did not show any effect of the edge-preserving bilateral filter for larger sphere sizes (30–50 mm).
For VOI41, VOIA41, VOIRTL and VOISchaefer bias increased for higher noise levels. The negative bias obtained with these four VOI methods was increased with 15% compared to normal noise levels (Table 1 and Supplementary Fig. 3a). Effects of applying the edge-preserving bilateral filter to data simulated at higher noise levels showed similar improvements as were observed for data simulated at normal noise levels (Table 1 and Supplementary Fig. 3b).
Phantom experiment
Figure 2 summarizes the results of the phantom experiment simulating effect of different TBRs (5 and 9) and scanner resolutions. Performance of GradWT and VOI41 improved by increasing resolution and TBR. VOIA41, VOIRTL and VOISchaefer were only slightly affected by increased TBR and resolutions. VOI41 showed poor performance for small sphere sizes, especially for a TBR of 5. Precision of the delineation methods was slightly different for the two scanners (data not shown). For example for the HR+, the largest sphere (37-mm diameter) showed an SD of 1.0–1.7% for TBR of 9, whereas the small sphere (13-mm diameter) showed an SD of 9.0–13%. For the GEMINI TF PET/CT system similar SDs were found (1.3–2.1% and 5.5–11%, respectively).
In this study, the main objective was to explore the performance dependence of several (semi-)automatic delineation methods [1–3, 14, 17] as function of different image characteristics in the case of [18F]FDG scans. For all methods substantial variation in bias was observed, but the different methods showed different sensitivities to variations in sphere size, TBR, reconstruction settings, image resolution and noise levels. Secondly, the paper intends to examine the potentially large errors that may occur when using these methods in a non-standardized or non-calibrated method. We also explored VOISchaefer without calibration and observed very high bias in measured volume (i.e. >38% bias for a 30-mm diameter sphere in the lung), which was strongly reduced after calibration (<7%). Therefore, in the present paper, in line with the recommendations pointed out in [1, 18], only VOISchaefer with calibration was used. An alternative approach would be to harmonize the image quality (i.e. spatial resolution, TBR and quantitative accuracy) across various sites as attempted by the recently published European Association of Nuclear Medicine (EANM) guidelines [19]. This approach would only be required when using methods that cannot be calibrated for specific imaging parameters, e.g. threshold-based methods, either with or without background corrections, in order to ensure inter-institute comparability of PET-based tumour volume assessments.
All delineation methods could not define tumour volume accurately for all sphere sizes, i.e. SUV2.5 showed large bias in estimating tumour volume (i.e. >25% bias for a 30-mm diameter sphere in the lung). As there are no 'normal' values of SUV that can be applied to every situation, it has been shown previously [5] that SUV2.5 can often fail to produce accurate tumour volumes, e.g. when the physiological background activity lies above the fixed threshold. The remaining methods (GradWT, VOI41, VOIA41, VOIRTL and VOISchaefer) provided acceptable accuracy, i.e. for spheres >20 mm they showed biases smaller than 18 and 23% for lung and mediastinum, respectively.
Fixed threshold-based methods (i.e. 41–70% of maximum voxel value) strongly depended on the threshold level chosen. Delineated volumes for higher thresholds are obviously smaller, resulting in underestimation of volumes. Advanced adaptive threshold-based methods (e.g. VOISchaefer) do not use a fixed threshold level, but also correct for background activity, and tumour volume or mean tumour intensity. The presented results showed minor dependence on noise, spatial resolution, acquisition parameters and reconstruction settings for VOISchaefer, as was expected when calibrating the method. Overall VOISchaefer seems to perform well over various simulated imaging characteristics.
Simulation studies
Based on the initial results, only five methods (GradWT, VOI41, VOIA41, VOIRTL and VOISchaefer) were evaluated further in relation to various imaging parameters. The accuracy of these methods was affected by tumour size, TBR, image resolution and noise level. By optimizing the imaging parameters the accuracy of the delineated volume estimates increased for all VOI methods investigated.
There was a large difference in accuracy of delineated volume between unsmoothed and smoothed images and/or at various noise levels. All VOI methods tested showed a poor performance for non-smoothed data, which is likely caused by the high noise levels in the computer-generated images. There are several possible causes for the noise dependence of various VOI methods. First of all, methods which use a percentage of maximum uptake to define the final contour are likely to be more sensitive to noise as noise may result in an upward bias of the maximum value. Consequently, the upward bias in the maximum value may result in higher isocontour values and thus in smaller volumes. Secondly, noise will impact the accuracy and precision of any 3-D region growing technique. Therefore, noise will directly impact the granularity of the observed contours and thereby accuracy of observed VOI. When noise levels become too high 3-D region growing algorithms may fail to generate a meaningful VOI. However, the difference in accuracy of delineated volume between smoothed (additional 5 mm FWHM) and more smoothed (additional 7 mm FWHM) was much less (Table 1 and Supplementary Fig. 2). In general, good accuracy (bias <12%) for the delineation methods was found when using 7 mm FWHM smoothed images. However, smoothing with 7 mm FWHM could induce partial volume effects and loss of detail [14]. The latter effect also explains why most methods have difficulty in providing accurate tumour volumes for small spheres. A lower resolution will also degrade the gradient between tumour and non-tumour tissue and, consequently, it will be more difficult for any VOI method to delineate the tumour boundaries. In the presence of lower gradients small uncertainties in the actual threshold being used by the VOI method for tumour delineation (as is the case for most VOI methods used in this study) could result in larger 'displacements' of the generated contour. In the case of gradient-based methods it is obvious that lower gradients will result in less accurate assessments of the position of the steepest gradient and thus in increased uncertainty and reduced accuracy of this method at lower resolutions.
The results obtained by changing noise levels and degree of smoothing indicate that there is a sensitive trade-off between noise and resolution. Ideally, images should have high spatial resolution and very low noise levels. However, in clinical practice some filtering is applied to reduce noise levels. As explained above, elevated noise levels may also hamper (semi-)automated tumour delineation and, especially when expected tumour sizes are large and have high FDG uptake, some filtering may be helpful to generate reliable tumour volume estimates. Yet, filtering degrades image resolution which in turn hampers tumour delineation for smaller tumours (e.g. <15 mm diameter) with lower uptakes (TBR <4). Therefore, in practice the trade-off between noise and resolution should be carefully considered and optimization of imaging parameters in combination with calibrating the VOI method (when possible for the envisioned method) is needed depending on the scanner, tracer, VOI method and tumour type and location.
Effects of an edge-preserving bilateral filter for denoising images were also investigated (Table 1 and Supplementary Fig. 3b). After applying the filter to data sets at two noise levels, the accuracy of all methods, except for GradWT, improved. Again this may illustrate the sensitivity of most VOI methods to noise. The lack of improvement of GradWT is not fully clear, but a possible explanation for overestimation of tumour volume could be that in our implementation a voxel will be assigned to tumour in case two watersheds are competing for the same voxel, i.e. border voxels are assigned as tumour. Further work is ongoing to enhance the performance of this method, e.g. by allowing for fractional voxels and/or using a higher image matrix size (upsampling). In addition, in this paper we explored the effects of noise reduction using Gaussian and bilateral filtering. It should be noted that both these filters do not take the Poisson nature of noise into account, i.e. the variance is proportional to the underlying signal. Possibly, tumour delineations will benefit from more sophisticated filtering approaches that include an estimate of local variance.
When using an iterative reconstruction algorithm, both quantitative accuracy and noise level depend on number of iterations. A higher number of iterations not only improves convergence and image contrast, but also increases image noise. Only small differences in bias (<3% lower) were observed when varying the number of iterations for each VOI method. This indicates that the chosen reconstruction setting does not show a large effect on accuracy of measured tumour volumes. Similar results were shown in a previous study [20] that more extensively evaluated the effects of various reconstruction algorithms and settings. It was shown that accuracy of measured volume varies only slightly with image reconstruction algorithm and smaller spheres (i.e. <2 ml) were affected more than larger spheres. The latter was also seen in the present study, i.e. accuracy of tumour volume was better for larger (>30 mm) than for smaller spheres.
Using the cross-shaped pattern to identify an averaged maximum or peak value and its location provided similar results as those based on the maximum (single) voxel value. Accuracy of GradWT and VOIRTL methods was similar for all spheres compared to using a single voxel maximum value. This can easily be understood as both methods do not use the maximum (or peak) voxel value. On the other hand, as can be expected, VOI41 and VOIA41 showed a small improvement by 3–6% (Table 1). In addition, the SD of these methods improved slightly when using the cross-shaped pattern, probably because the effects of noisy voxels are reduced by using an average value. Using a cross-shaped pattern did improve performance of percentage threshold-based methods and therefore it is recommended to use this approach for initialization, especially when percentage threshold-based methods are used.
Phantom studies
Similar to what was observed in the simulation studies there was a limitation in defining volumes for the smaller spheres (diameter <15 mm, Fig. 2). Therefore, the smallest sphere gave large biases for all methods (sometimes >70%). For all delineation methods, the best performance was observed for sphere sizes larger than 15 mm diameter. For the HR+ and the GEMINI TF, VOISchaefer seemed to be the best method on average.
Moreover, this study showed that effective threshold-based methods that correct for local background activity (i.e. VOIA41 and VOIRTL), contrast-oriented (i.e. VOISchaefer) as well as gradient-based methods are useful for defining tumour volume. However, optimal percentage threshold level and/or optimal settings strongly depend on imaging parameters. Likewise, VOISchaefer needs reassessment of the method's parameters as function of image characteristics (mainly image resolution). This implies that calibration of VOI methods and/or (in combination with) optimization of PET procedures is required when PET images are used for tumour delineation [19].
Firstly, tumours in both experiments were represented by homogeneous 3-D spheres, thereby excluding effects of tumour shape and heterogeneity. Therefore, even methods that showed good performance in the present paper should be used with care and need to be supervised in the case of (non-spherical) tumours showing heterogeneous tracer uptake. Widely available methods that can accurately deal with variation in imaging characteristics and tracer uptake heterogeneity are needed. In this respect the fuzzy locally adaptive Bayesian method published by Hatt et al. [21] appears to be very promising. Secondly, in the phantom experiments, but not in the simulations, background activity was uniform around the tumour. This is usually not the case in actual human PET studies and higher local uptake (e.g. due to inflammation) may result in errors when defining tumour contours. On the other hand, for the phantom experiments the wall of the spheres, resulting in a shell of 'zero' activity around the spheres, may have affected performance evaluation [22]. Yet, phantom study results were similar to those seen in simulation results and vice versa. Finally, this study focused on tumours located in the thorax. Therefore, all methods should be evaluated further for other body regions and using clinical data. Even with these 'simple' conditions, however, it is clear that differences in image characteristics, caused by differences in reconstruction settings, image filtering and noise levels, can have a pronounced effect on performance of the (semi-)automatic delineation methods investigated, although magnitude and direction of those effects may be different among (semi-)automatic delineation methods.
Differences in imaging parameters can have a pronounced effect on the performance of (semi-)automated methods to delineate tumours. This implies that PET data collection and image reconstruction procedures and the (semi-)automated tumour delineation methods need to be standardized and calibrated for each scanner for reproducible and accurate tumour delineations.
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The authors would like to thank N.J. Hoetjes for assistance in acquiring phantom data and the radiochemistry staff for production of isotopes. This study was performed within the framework of CTMM, the Center for Translational Molecular Medicine, AIRFORCE project (grant 03O-103). Patsuree Cheebsumon was supported by a scholarship from the National Science and Technology Development Agency of the Royal Thai Government.
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Supplementary Fig. 1
Accuracy of selected delineation methods as function of sphere size for a TBR of 4 (a) and 12 (b). Note that some data fall outside the scale of the figure (> ±34%) and that some symbols overlap. (JPEG 15 kb)
Supplementary Fig. 2
Accuracy of selected delineation methods as function of sphere size for a non-smoothed data, b smoothed data with 5 mm FWHM Gaussian filter and c smoothed data with 7 mm FWHM Gaussian filter. Note that some data fall outside the scale of the figure (> ±50%) and that some symbols overlap. (JPEG 22 kb)
Supplementary Fig. 3
Accuracy of selected delineation methods as function of sphere size for the higher noise level data obtained by adding ~47% COV of noise (a) and with additional image denoising using an edge-preserving bilateral filter (b). Note that some data fall outside the scale of the figure (> ±30%) and that some symbols overlap. (JPEG 15 kb)
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Cite this article
Cheebsumon, P., Yaqub, M., van Velden, F.H.P. et al. Impact of [18F]FDG PET imaging parameters on automatic tumour delineation: need for improved tumour delineation methodology. Eur J Nucl Med Mol Imaging 38, 2136–2144 (2011). https://doi.org/10.1007/s00259-011-1899-5
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DOI: https://doi.org/10.1007/s00259-011-1899-5
- Tumour delineation
- Volume of interest (VOI)
- Positron emission tomography (PET)
- Tumour volume


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• The "Daytona Yellow" paint formulation was used by Chevrolet on its Camaro and Corvette models in 1969 and 1970.
• Variations of this yellow automotive paint color are also known as Bright Yellow, Goldenrod Yellow, Yellow and Colonial Yellow.
• The paint code of Daytona Yellow was used on several General Motors Corp. and Chrysler models (including the Firebird, Pontiac, Camaro, Corvette, Chrysler Special Order/Fleet, Oldsmobile, Chevrolet, Nova, Buick and GMC.), but the sales name of the color changed based on which car it was used on.
• The only instances in which it was called "Daytona Yellow" by the factory was on the '69 and '70 Camaros and Corvettes.
Below are paint schemes for 11 additional cars in the 19-car race.


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Why do gums recede? Which are the treatments for gingival or gum recession?
This works, (gum grafting) it's painful in the area where they take the tissue for a few weeks but not a huge deal. If you're getting it in an area that no one will see when you smile, then don't worry about it. However, some people's gums easily show when they talk or smile. This doesn't match your gum 100%. The tissue color is different (whiter), you can tell something is off. If you're getting this done in a highly visible area and are concerned about aesthetics, I'd ask to see before and after photos.
Peter J Puleo:
Caused mostly by genetics and aging, according to my dentist. I have receding gums and I take extreme care of my gums and teeth. This surgery is very expensive, probably painful, and possibly unnecessary accept in very severe cases at a young age.
Amanda Wells:
I got this surgery done on one of my top teeth, it healed nicely. Almost all my bottom teeth except the molars are receded and very thin gum tissue. I got surgery 2x and it didnt work
Pat Hannah:
'grafting material obtained from animals or humans' Exactly what type of animals you're getting this from, and/or do the humans have to be dead?
Eliza Gaskell:
Didn't know this was possible. Good to know such things are possible. Whilst it looks terrible and painful I'd rather do this because the alternative is to lose your teeth.
Jessica Monteferrante:
Amazing video!
Vakada Lakshmana Siva Kumar:
Same problem suffering my husband side daNtham 2nd one no fungus or infection but more pain doctor root canal suggested but he was not interested, ur video is very useful to me, I will try this type of treatment available in Rjy local doctors thank you


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What movies did Viola Davis play in? Take a look at the roles she's starred in over the years! Davis is the first African-American actor to achieve the Triple Crown of Acting: an Oscar, an Emmy, and a Tony award! With an incredible acting career since the '80s, you may be asking yourself, what movies did Viola Davis play in?
What movies did Viola Davis play in?
What movies did Viola Davis play in? Viola Davis has been in over 45 movies AND a handful of Broadway and television roles since her time as an actress! Born in South Carolina and raised in Rhode Island, Davis had a rather tumultuous childhood growing up. Yet, she credits her high school for helping her find passion in theatre and the arts!
Viola Davis now has numerous accolades under her acting resumé and is one of the leading ladies of Hollywood! So far, she's been nominated 213 times and has won 102 of those awards... incredible! Find out what Viola's best roles are right here!


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NYISE Students Perform at Church of the Intercession service.
NYI students Aolani and Isabelle were requested to perform at the Church of the Intercession at Washington Heights. They sang at the Spanish/English service celebrating Dominican Independence Day. The church's music director heard the girls sing during the church's Christmas Holiday performance and has nothing but praise for the music program of our Mr. Naum.


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Registration No.: 2020/TEN/556/BK4/19
About Us
Who we are?
Satyalok is a Jharkhand-based non-profit and non-government organization.
It is a platform created and driven by energetic young individuals who desire to uplift their surrounding communities from the manacles of poverty.
We are devoted towards comprehensive and inclusive development.
The goal is to achieve this in the local marginalized communities by fulfilling basic needs like balanced diet for the children, good quality education, affordable and adequate health care, and reliable shelter over their heads.
At present, we operate in a 20 km radius around Kathara.
We provide mid-day meals, healthcare, quality education, skill development lessons and guidance for future opportunities to underprivileged children.
We also conduct sanitation and afforestation initiatives to improve the environment in and around these communities.
Mission & Vision
Satyalok aims at making the world a better place for the less privileged among us.
This can be achieved through targeted social reforms in people and environment.
We are working to improve the quality of life in vulnerable communities around us through access to basic amenities like food, healthcare, education as well as opportunities for skill development and employment. We also distribute food, warm clothes, footwear and facilitate emergency healthcare to take care of immediate needs.
Our goal is to attain sustainable progress through empowerment, livelihood and self-reliance.
Satyalok's initiatives for a cleaner and healthier environment include plantation and cleanliness drives, pamphlets to spread awareness about current issues including COVID-19 and much more.
We are dedicated to our mission and vision to make the world a better place. We have started our efforts in a radius of around 20 km in our vicinity. Once tangible success is achieved here, we intend to grow into adjoining areas.
Founder's Profile
Mr. Satyendra Narayan Rai
Physical Education Teacher at D.A.V. Public School, Sawang authorized by DAV Managing Committee and recognized by Central Board For Secondary Education (C.B.S.E.), New Delhi, India.
Currently living in Sawang, Bokaro Jharkhand.
Satyendra Narayan Rai Sir started his work for social welfare way back in 2002 when he teamed up with some of his students to construct a road for the residents of Teachers Colony, Kathara.
Cut to 2020, when the global pandemic ravaged the world and took its toll on every section of our society, he and his students banded together once more to help the needy and vulnerable. They started by helping people with food, masks, hand-wash and awareness to fight against COVID-19. Their operations gradually expanded from there to a broader focus area to uplift the community in a sustainable way.


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Interview with Karen Schüssler
Founded in 1993, the Institute for Plastination has overseen the touring programme of one of the most controversial and fascinating travelling exhibitions in the world: Body Worlds. We spoke with Director of Exhibitions and Marketing Karen Schüssler about its enduring popularity, and what the future holds for the IfP.
TEN: Can you tell us a little bit about Body Worlds and the IfP's focus on education – both for medical professionals and the public?
Karen Schüssler: BODY WORLDS aims to educate the public about the inner workings of the human body and shows the effects of poor health, good health, and lifestyle choices. It is also presented in the hopes that it will motivate visitors to learn more about the science of anatomy and physiology.
The BODY WORLDS exhibitions offer valuable insights for laymen as well as for persons with a medical background.With the Plastinarium in Guben we created the perfect environment to actively learn, understand and study plastination and anatomy. We offer courses in plastination and anatomy at various levels, including pre-med students and professionals.
TEN: The IfP Plastinarium in Guben is visited by the students and professionals you mention – what's the relationship between the Plastinarium and these external individuals?
KS: The Plastinarium is the perfect place for professionals who are interested in anatomy and plastination courses or who are looking for surgical training, for professional development. Rather than teaching with books we are using plastinates and more practical approaches to learn anatomy.
We offer advanced levels of plastination courses for professionals who already plastinate or who are planning to open their own plastination laboratory. The plastination courses provide the basis of the process such as proper wet dissection of specimens and covers the main steps of the technique such as dehydration, vacuum forced impregnation and curing. In addition, it teaches the silicone plastination method in more detail. For experienced plastination professionals we offer customised lessons in specialised fields such as preventing shrinkage, colouring, special injection methods and more.
Furthermore our unique facilities are ideal for dissection/surgical training, medical research and medical engineering.
To date more than 40 million people visited 140 BODY WORLDS exhibitions in more than 90 cities and 20 countries, making them one of the most successful traveling exhibitions of all time.
As the leader in plastination, our range of innovative educational resources is designed to teach current and future medical and healthcare professionals. Improving the anatomical knowledge and education of future doctors is ingrained in our service and commitment to the medical and health sciences.
TEN: And what about the International Plastination Conference – what does this involve and who attends?
KS: The International Society for Plastination is a multidisciplinary organisation, including people within all fields of science interested in the technique of plastination. The International Society for Plastination was founded in 1986 in San Antonio, Texas.
Its functions are as follows:
- Identify an international community of scientists and technologists interested in plastination
- Compile a list of all laboratories involved in plastination, including a description of the techniques being practiced at each institute
- Serve as a forum for the exchange of information about plastination
- Publish the Journal of the International Society for Plastination
- Organise and conduct meetings and workshops
- Define plastination as an area of professional activity and provide a means of learning and practicing plastination as a career
The International Society holds an International Conference of Plastination every two years. The Institute for Plastination, as a member of the Society for many years, has hosted the Conference at our Institute in Heidelberg. More information can be found at: isp.plastination.org
TEN: Another important part of the IfP's work is the exhibitions it puts on, can you explain what the Institute aims for with these?
KS: The primary goal of BODY WORLDS is health education. On the one hand, individual specimens are used to compare healthy and diseased organs, i.e., a healthy lung with that of a smoker, to emphasise the importance of a healthy life-style. On the other hand, life-like posed whole-body plastinates illustrate where in our bodies these organs are positioned and what we are: naturally fragile in a mechanised world.
Learn more about the plastination process:
Thus, the exhibitions are targeted mainly at a lay audience and open up the opportunity to better understand the human body and its functions. The exhibits remind visitors of the fragility, individuality and anatomical beauty underneath their skin.
TEN: How many exhibitions have been toured as part of the IfP's work over the last decades?
KS: To date more than 40 million people visited 140 BODY WORLDS exhibitions in more than 90 cities and 20 countries, making them one of the most successful traveling exhibitions of all time.
Actually, there are 10 exhibitions concurrently presented in Europe and America, at this time. Most of them are touring exhibitions that change location every 3-6 months. Furthermore two exhibitions (one in Amsterdam and another in New York) are on display permanently, in Berlin, the first BODY WORLDS Museum, titled the Menschen Museum opened in February 2015.
Last but not least our Anatomical Teaching Centre in Guben, the Plastinarium, combines the moving experience of seeing a BODY WORLDS Exhibition with an opportunity to witness first-hand, and see some essential steps of the plastination process first-hand.
TEN: How do the various exhibitions that are being shown differ from each other?
KS: While all of the BODY WORLDS exhibitions focus on general anatomy revealed through Plastination, each exhibition focuses on a dedicated theme – for example cardiology and the heart, the body's capability and vitality, human development, longevity and aging, the story of the human body in the 21st century, and the effect of happiness of the human body.
Even after 20 years of exhibition history, the fascination with the mysteries of the human body and the quest for a long, healthy life continue to exude the same magnetism as always.
The exhibitions show a multitude of brand new plastinates and offer every visitor – even the ardent BODY WORLDS visitor – a fascinating exhibition experience.
TEN: Has demand to see these kinds of exhibitions continued steadily?
KS: Even after 20 years of exhibition history and with more than 40 million visitors around the world, the fascination with the mysteries of the human body and the quest for a long, healthy life continue to exude the same magnetism as always. There is always a new audience of school children and medical professionals beginning training that maintain a high demand for the exhibition. Additionally, we have found that as our human bodies change throughout our lives, we seek new information on how new ailments or achievements in our lives might look on the inside. This never-ending curiosity is likely another reason for the continued demand for the exhibitions.
TEN: What does the future hold for the BODY WORLDS exhibitions? Will they continue to change as new technology and methods become available?
KS: Plastinates always have been and will stay the focus of the BODY WORLDS exhibitions. But since the first exhibition, more than 20 years ago, there have been some major improvements in relation to the quality of the plastinates. Especially the stability of the blood vessels has been considerably improved, which facilitates the transport and makes the plastinates more stable.
Dr Gunther von Hagens has completed vast research in the field of slice production over the recent years. This has led to very thin and precise slices of plastinates that have been very helpful in the education of orthopaedic studies.
These improvements have been achieved through the continuing refinement of the plastination process, which we hope our Institute will continue for many years to come.
» We're pleased to welcome BODY WORLDS back as a sponsor for TEM this year, and you can read our company report here
READ MORE: www.bodyworlds.com
See conference and sponsoring information about TEM2015 here: touringexhibitions.org/sponsoring


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Elmer T. Lee
Regular price $139.99
Unit price per
Bottle Size: 750mL Bourbon (45.00% ABV)
Description: Named after Master Distiller Emeritus Elmer T. Lee, this whiskey is hand selected and bottled to the taste and standards which were set forth by Elmer T. Lee himself. The nose brings notes of clove, vanilla, and old leather. The flavor balances fruit, honey and vanilla with a light spiciness. A long and warm finish.


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ALBANY — The pace of new coronavirus cases continues to fluctuate in Albany County, with 10 new positive cases revealed Monday, but officials say the relatively low numbers offer hope for the start of in-class schooling.
Of the new cases, one individual was a health care worker, five had close contact with others who had contracted the virus and one had traveled out of state. It was unclear where the remaining three had contracted the virus from, County Executive Dan McCoy said during a briefing Monday morning.


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$ 50 billion in reserves from the central Iraqi foreign currency
$ 50 billion in reserves from the central Iraqi foreign currency
Palm – The Iraqi Central Bank Governor Sinan Shabibi, on the composition of foreign reserves to support the value of Iraqi dinar stood at fifty billion dollars, noting that the Iraqi dinar is stable currencies in the region.
He explained in a speech during a session of parliament, that the CBI has sought Bmlake national and experience high to set monetary policy consistent and rational achieved financial stability in the country, pointing out that the only party in Iraq, which is unique in producing a public good directly to maintain the purchasing power of the Iraqi dinar.
He Shabibi in a speech to achieve these results in very harsh conditions was the bank which to terrorist acts, and although this did not shake the will of the workers and continued to work to make the bid, saying that the issue of the reserve, or the cover of currency comes at the request of the government and the Ministry of Finance, stressing support the importance of the size of the reserve currency in circulation, because the affected reserves will impact on the fiscal balance.
Furthermore, Al adviser to the CBI the appearance of Mohammed Saleh, measures to reduce cash sales in its daily auction for the sale of foreign currencies as of this week, revealing that speculators were behind the high exchange rate locally for quick profit.
The CBI stressed its procedures for the sale of cash during the last period, the condition of the banks to bring legal documents at the request of foreign exchange, which hampered its work and importers of goods and commodities in and explained that the Central decided to cut the proceedings at the request of documents during the week of the receipt of cash, as can private banks participating in the auction of foreign currencies foreign exchange demand at any time and the exchange rate was over 119 thousand dinars per hundred dollars last week, after it was below 118 thousand.
Saleh pointed out that the sale remittances outside Iraq allowed for commercial purposes, and according to legal documents, citizens can also transfer the funds to pay fees for university students or outside of Iraq for medical treatment and for other purposes, not inconsistent with the law against money laundering.
Drawer and the Iraqi Central Bank to hold five meetings a week for an auction sale or purchase of foreign currencies, and receive a cash sales of 13 dinars per dollar as commission, and 13 dinars per dollar on the sale of remittances outside Iraq.


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There's been much anticipation for Guillermo del Toro's latest feature. With a highly successful festival run (taking home best director and score at the illustrious Venice Film Festival), Oscar buzz, a much earlier US release date to rave reviews, one wonders how much salt to digest with The Shape of Water. The hype is justified; del Toro has crafted his best English feature, well on the same level of his early Spanish works – Devils Backbone and Pans Labyrinth. This is a beautifully shot and written romantic period piece.
Set in cold-war 1962 America the story is simple enough. The casting, dialogue and themes are anything but. Sally Hawkins is phenomenal in the starring role of Elisa, a mute janitor working in a military facility. Del Toro wrote the character with her specifically in mind describing her as the stranger on a bus with luminosity and an ethereal quality. It's a perfect characterisation of her in this.
It's a content but mundane existence until she is tasked with the upkeep of a secret new project. That project is the captivity of a strange amphibian beast. Captured within the Amazon by the villainous Michael Shannon, who runs the facility it's now housed in. Revered as a god by the native Amazonians, the military views the creature as nothing more than an asset to learn from, possibly gaining an upper hand on the Ruskis. Elisa on the other hand, sees a kindred spirit in the amphibian man, making a deep connection with the only other sentient being she knows to be trapped without a voice.
Comparisons to Abe Sapien of the Hellboy adaption have been flatly denied by del Toro. Though it's hard to ignore with the physical similiarities and both being played by the immensely talented Doug Jones. Links to the amphibious beast of Creature from the Black Lagoon are much more tantalising and revealing of the nature of the film.
Guillermo del Toro is the master of subversion. Not unlike many of the classic Universal monsters from the pre cold war era The 'creature' from the Black Lagoon was a beast to be feared and pitied for his lonely tragic demise and obsession with that films heroine. Shape of Water inverts the narrative portraying Michael Shannon's character as the entity of power and monstrosity.
Guillermo del Toro manages to both romanticise and criticize the period deftly. The set and props are intricate and sublime, containing wainscot paneling, wall paper, timber floors and ceilings, chrome finished luxury cars. Harking back to the idealised post war boom of perfect lawns and friendly neighbors, ie the period when classic monster movies flourished. It's within the well crafted characters that del Toro exposes much of the myth of those times. Elisa's neighbor the sensitive painter Giles (Richard Jenkins) is ostracized for the sexuality he has been forced to hide for a lifetime. Her best friend Zelda (Octavia Spencer) is regularly mistreated for her skin colour. In one particularly devious moment Michael Shannon refers to Zelda and himself as humans crafted in the likeness of God, though her perhaps not so much.
The story, like the name is deeply poetic, an unusual and intimate love story. Complimenting that, is the score which pays tribute to the magical qualities of the black and white musical numbers of the 30's, renowned composer Alexandre Desplat is to thank. The cinematography is likewise phenomenal, Dan Lausten creates a teal world of blue and green, tying together some important themes, while also meshing a Victorian gothic vibe with 60's suburbia. The underwater sequences are works of art to be admired. It's a complete film that works resoundingly on every level.
The Shape of Water is in cinemas from 18th January through 20th Century Fox.