Abstract
In this paper, we propose a novel image segmentation algorithm that is based on the probability distributions of the object and background. It uses the variational level sets formulation with a novel region based term in addition to the edge-based term giving a complementary functional, that can potentially result in a robust segmentation of the images. The main theme of the method is that in most of the medical imaging scenarios, the objects are characterized by some typical characteristics such a color, texture, etc. Consequently, an image can be modeled as a Gaussian mixture of distributions corresponding to the object and background. During the procedure of curve evolution, a novel term is incorporated in the segmentation framework which is based on the maximization of the distance between the GMM corresponding to the object and background. The maximization of this distance using differential calculus potentially leads to the desired segmentation results. The proposed method has been used for segmenting images from three distinct imaging modalities i.e. magnetic resonance imaging (MRI), dermoscopy and chromoendoscopy. Experiments show the effectiveness of the proposed method giving better qualitative and quantitative results when compared with the current state-of-the-art.

Abstract
This paper studies the use of non-invasive acoustic emission recordings for clinical device tracking. In particular, audio signals recorded at the proximal end of a needle are used to detect perforation events that occur when the needle tip crosses internal tissue layers. A comparative study is performed to assess the capacity of different features and envelopes in detecting perforation events. The results obtained from the considered experimental setup show a statistically significant correlation between the extracted envelopes and the perforation events, thus leading the way for future development of perforation detection algorithms.

Abstract
The teaching process of auscultation is complex in itself, and difficult to operate since it requires a wide spectrum of patients with the most diverse cardiopulmonary pathologies, readily available during teaching and assessment hours, for an ever-growing number of medical students. In this paper we will focus on how virtual patient technologies can promote the evolution of the current teaching methodologies, promoting better learning. The chosen methodology was: a) a review of available medical simulation technologies for auscultation teaching; b) a case study illustrating how a virtual patient simulation technology has been successfully used to teach and certify auscultation skills. Results show the positive impact and high acceptability of virtual patient simulation technologies in the teaching of auscultation to medical students.

Abstract
In this paper, we consider the problem of classifying skin lesions into multiple classes using both dermoscopic and clinical images. Different convolutional neural network architectures are considered for this task and a novel ensemble scheme is proposed, which makes use of a progressive transfer learning strategy. The proposed approach is tested over a dataset of 4000 images containing both dermoscopic and clinical examples and it is shown to achieve an average specificity of 93.3% and an average sensitivity of 79.9% in discriminating skin lesions belonging to four different classes.

Abstract
Objective Artificial intelligence (AI) may reduce underdiagnosed or overlooked upper GI (UGI) neoplastic and preneoplastic conditions, due to subtle appearance and low disease prevalence. Only disease-specific AI performances have been reported, generating uncertainty on its clinical value. Design We searched PubMed, Embase and Scopus until July 2020, for studies on the diagnostic performance of AI in detection and characterisation of UGI lesions. Primary outcomes were pooled diagnostic accuracy, sensitivity and specificity of AI. Secondary outcomes were pooled positive (PPV) and negative (NPV) predictive values. We calculated pooled proportion rates (%), designed summary receiving operating characteristic curves with respective area under the curves (AUCs) and performed metaregression and sensitivity analysis. Results Overall, 19 studies on detection of oesophageal squamous cell neoplasia (ESCN) or Barrett's esophagus-related neoplasia (BERN) or gastric adenocarcinoma (GCA) were included with 218, 445, 453 patients and 7976, 2340, 13 562 images, respectively. AI-sensitivity/specificity/PPV/NPV/positive likelihood ratio/negative likelihood ratio for UGI neoplasia detection were 90% (CI 85% to 94%)/89% (CI 85% to 92%)/87% (CI 83% to 91%)/91% (CI 87% to 94%)/8.2 (CI 5.7 to 11.7)/0.111 (CI 0.071 to 0.175), respectively, with an overall AUC of 0.95 (CI 0.93 to 0.97). No difference in AI performance across ESCN, BERN and GCA was found, AUC being 0.94 (CI 0.52 to 0.99), 0.96 (CI 0.95 to 0.98), 0.93 (CI 0.83 to 0.99), respectively. Overall, study quality was low, with high risk of selection bias. No significant publication bias was found. Conclusion We found a high overall AI accuracy for the diagnosis of any neoplastic lesion of the UGI tract that was independent of the underlying condition. This may be expected to substantially reduce the miss rate of precancerous lesions and early cancer when implemented in clinical practice.

Abstract
In this work, we propose a novel algorithm for heart sound segmentation. The proposed approach is based on the combination of two families of state-of-the-art solutions for such problem, hidden Markov models and deep neural networks, in a single training framework. The proposed approach is tested with heart sounds from the PhysioNet dataset and it is shown to achieve an average sensitivity of 93.9% and an average positive predictive value of 94.2% in detecting the boundaries of fundamental heart sounds.