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The study introduces an adaptive switching interpolation filter (ASIF) for restoring images contaminated with salt & pepper impulse noise. The new method restores noisy pixels by applying a new interpolation scheme that combines Shepard's inverse distance weighting and Simpson's natural neighbour interpolation techniques. The new interpolation scheme is designed based on the percentage of the overlapping area and the distance between the sites created by noisy pixels with the sites of uncorrupted pixels in the Voronoi tessellation. Since natural neighbour-based techniques do not support extrapolation, the proposed algorithm performs Shepard's inverse distance weighting-based restoration when the noisy pixels fall outside the convex hull formed by uncorrupted pixels. As the proposed method combines the advantages of Simpson's natural neighbour and Shepard's inverse distance weighting interpolation methods, it better preserves the natural intensity variations in images and provides smoother approximation than other methods used in the comparative study. Visual and quantitative experimental analysis performed on various images with peak signal to noise ratio, mean structural similarity index measure, image enhancement factor, and feature-similarity index measure demarcates the improved capability of ASIF over other comparative filters.

Introduction Future conflicts may have limited use of aviation-based prehospital emergency care for evacuation. This will increase the likelihood of extended evacuation timelines and an extended hold at a forward hospital care facility following the completion of damage control surgery or acute medical interventions. Methods A three-round Delphi Study was undertaken using a panel comprising 44 experts from the UK armed forces including clinicians, logisticians, medical planners and commanders. The panel was asked to consider the effect of an extended hold at Deployed Hospital Care (Forward) from the current 2-hour timeline to +4, +8, +12 and +24 hours on a broad range of clinical and logistical issues. Where 75% of respondents had the same opinion, consensus was accepted. Areas where consensus could not be achieved were used to identify future research priorities. Results Consensus was reached that increasing timelines would increase the personnel, logistics and equipment support required to provide clinical care. There is a tipping point with a prolonged hold over 8 hours, after which the greatest number of clinical concerns emerge. Additional specialties of surgeons other than general and orthopaedic surgeons will likely be required with holds over 24 hours, and robust telemedicine would not negate this requirement. Conclusions Retaining acute medical emergencies at 4 hours, and head injuries was considered a particular risk. This could potentially be mitigated by an increased forward capacity of some elements of medical care and availability of a CT scanner and intracranial pressure monitoring at over 12 hours. Any efforts to mitigate the effects of prolonged timelines will come at the expense of an increased logistical burden and a reduction in mobility. Ultimately the true effect of prolonged timelines can only be answered by close audit and analysis of clinical outcomes during future operations with an extended hold.