Object Detection During Newborn Resuscitation Activities

Birth asphyxia is a major newborn mortality problem in low-resource countries. International guideline provides treatment recommendations; however, the importance and effect of the different treatments are not fully explored. The available data is collected in Tanzania, during newborn resuscitation, for analysis of the resuscitation activities and the response of the newborn. An important step in the analysis is to create activity timelines of the episodes, where activities include ventilation, suction, stimulation etc. Methods: The available recordings are noisy real-world videos with large variations. We propose a two-step process in order to detect activities possibly overlapping in time. The first step is to detect and track the relevant objects, like bag-mask resuscitator, heart rate sensors etc., and the second step is to use this information to recognize the resuscitation activities. The topic of this paper is the first step, and the object detection and tracking are based on convolutional neural networks followed by post processing. Results: The performance of the object detection during activities were 96.97 % (ventilations), 100 % (attaching/removing heart rate sensor) and 75 % (suction) on a test set of 20 videos. The system also estimate the number of health care providers present with a performance of 71.16 %. Conclusion: The proposed object detection and tracking system provides promising results in noisy newborn resuscitation videos. Significance: This is the first step in a thorough analysis of newborn resuscitation episodes, which could provide important insight about the importance and effect of different newborn resuscitation activitiesComment: 8 page

Activity Recognition From Newborn Resuscitation Videos

Objective: Birth asphyxia is one of the leading causes of neonatal deaths. A key for survival is performing immediate and continuous quality newborn resuscitation. A dataset of recorded signals during newborn resuscitation, including videos, has been collected in Haydom, Tanzania, and the aim is to analyze the treatment and its effect on the newborn outcome. An important step is to generate timelines of relevant resuscitation activities, including ventilation, stimulation, suction, etc., during the resuscitation episodes. Methods: We propose a two-step deep neural network system, ORAA-net, utilizing low-quality video recordings of resuscitation episodes to do activity recognition during newborn resuscitation. The first step is to detect and track relevant objects using Convolutional Neural Networks (CNN) and post-processing, and the second step is to analyze the proposed activity regions from step 1 to do activity recognition using 3D CNNs. Results: The system recognized the activities newborn uncovered, stimulation, ventilation and suction with a mean precision of 77.67 %, a mean recall of 77,64 %, and a mean accuracy of 92.40 %. Moreover, the accuracy of the estimated number of Health Care Providers (HCPs) present during the resuscitation episodes was 68.32 %. Conclusion: The results indicate that the proposed CNN-based two-step ORAAnet could be used for object detection and activity recognition in noisy low-quality newborn resuscitation videos. Significance: A thorough analysis of the effect the different resuscitation activities have on the newborn outcome could potentially allow us to optimize treatment guidelines, training, debriefing, and local quality improvement in newborn resuscitation.Comment: 10 page

Generalized vs Specialized activity recognition system for newborn resuscitation videos using Deep Neural Networks.

Birth asphyxia is a global problem which has resulted in a high mortality rate of newborn babies all over the globe, it is a newborn’s inability to establish breathing at birth. A notable breakthrough is the marrying of medical technology with information technology in an attempt to tackle this global health problem. An example of this is the Safer Births project which is focused on establishing technological advancement to curb newborn deaths. In the year 2013, the Safer Births project started and has till date gathered a lot of data captured during resuscitation sessions. The Haydom data used for the Safer Births project and additional data from Nepal and SUS will be used with the aim of comparing a specialized and generalized model trained on activity recognition system I3D and RGB stream excluding optical flow. With focus on only the newborn region, the reason for this is to simplify the existing model. The experiment was conducted in view of the possibility of achieving a system that can generalize or specialize with a combination of different hospital data on some specific activities of interest namely Ventilation, Suction, Stimulation. A new simplified pipeline, which is a reduction of the previous work done by the saferbirth group, showed a very poor performance when generalized

NewbornTime - improved newborn care based on video and artificial intelligence - study protocol

Background Approximately 3-8% of all newborns do not breathe spontaneously at birth, and require time critical resuscitation. Resuscitation guidelines are mostly based on best practice, and more research on newborn resucitation is highly sought for. Methods The NewbornTime project will develop artificial intelligence (AI) based solutions for activity recognition during newborn resuscitations based on both visible light spectrum videos and infrared spectrum (thermal) videos. In addition, time-of-birth detection will be developed using thermal videos from the delivery rooms. Deep Neural Network models will be developed, focusing on methods for limited supervision and solutions adapting to on-site environments. A timeline description of the video analysis output enables objective analysis of resuscitation events. The project further aims to use machine learning to find patterns in large amount of such timeline data to better understand how newborn resuscitation treatment is given and how it can be improved. The automatic video analysis and timeline generation will be developed for on-site usage, allowing for data-driven simulation and clinical debrief for health-care providers, and paving the way for automated real-time feedback. This brings added value to the medical staff, mothers and newborns, and society at large. Discussion The project is a interdisciplinary collaboration, combining AI, image processing, blockchain and cloud technology, with medical expertise, which will lead to increased competences and capacities in these various fields.publishedVersio

Regulation number 61-102 standards for licensing birthing centers for deliveries by midwives

This regulation establishes standards and procedures for birthing centers to ensure patient safety and quality of care

Neonatology. Introduction

Навчальний посібник містить інформацію про основні принципи догляду за новонародженими дітьми, перехідні умови та годування немовлят, основні принципи реанімації новонароджених. Для англомовних студентів вищих навчальних закладів III-IV рівнів акредитації, аспірантів, неонатологів, сімейних лікарів, педіатрів, терапевтів, акушерів та гінекологів.This study guide contains information about basic principles of care of newborn babies, transitory conditions and feeding of infants, main principles of neonatal resuscitation. For English-speaking students of higher educational institutions of III–IV levels of accreditation, postgraduates, neonatologists, family physicians, pediatricians, internists, obstetricians and gynecologists

Vision graph neural network-based neonatal identification to avoid swapping and abduction

Infant abductions from medical facilities such as neonatal switching, in which babies are given to the incorrect mother while in the hospital, are extremely uncommon. A prominent question is what we can do to safeguard newborns. A brand-new vision graph neural network (ViG) architecture was specifically created to handle this problem. Images were divided into several patches, which were then linked to create a graph by connecting their nearest neighbours to create a ViG model, which converts and communicates information between all nodes based on the graph representation of the newborn's photos taken at delivery. ViG successfully captures both local and global spatial relationships by utilizing the isotropic and pyramid structures within a vision graph neural network, providing both precise and effective identification of neonates. The ViG architecture implementation has the ability to improve the security and safety of healthcare facilities and the well-being of newborns. We compared the accuracy, recall, and precision, F1-Score, Specificity with CNN, GNN and Vision GNN of the network. In that comparison, the network has a Vision GNN accuracy of 92.65%, precision of 92.80%, F1 score of 92.27%, recall value of 92.25%, and specificity of 98.59%. The effectiveness of the ViG architecture was demonstrated using computer vision and deep learning algorithms to identify the neonatal and to avoid baby swapping and abduction

Regulation 61-102 standards for licensing birthing centers for deliveries by midwives

This regulation establishes standards and procedures for birthing centers to ensure patient safety and quality of care

From Charles Darwin to Sherlock Holmes: contributions of evolutionary psychology in forensic science investigation

Introduction Evolutionary psychology (EP) is a discipline born between evolutionary biology, cognitive science, and physical anthropology. It's both a theoretical and practical scientific discipline which principal purpose is to study human behavior, in order to understand the biological and evolutionary causes that generated it. Evolutionary psychology finds its roots in the Darwinian theory, considering human behavior as the product of adaptations to recurring problems in the ancestral environment, which evolved as functional results of natural or sexual selection forces. A branch of this discipline, Evolutionary forensic psychology, is a burgeoning fieldwhich explores the application of science and the profession of psychology to questions and issues relating to the law and legal systems. It make use of empirical methodologies, as fieldwork, the method mutually exclusive of multiple hypotheses, and the deductive investigative logic, which allowsto create psychological profiles. These profiles are based on objective data from the analysis of the cases, and aim to predict and understand biological motives that led people to commit violent behavior. Evolutionary forensic psychology promise to be a useful tool to study and analyze the variables of different situations, in order to assist and direct police and defensive investigations. In this PhD research I addressed different aspects and applications of this discipline. In the specific, during my research period at Philippe-Pinel research institute of Montrèal, Canada, I have explored the application of evolutionary psychology in the study of presence, a psychological state akin to perceptual illusion, first identified by cognitive and cyber psychology, and here analyzed as sexual presence. However , my research has mainly concentrated on the study of the adaptive value of maternal infanticide, with a special focus on the phenomenon of maternal neonaticide, here meant as "reproductive disinvestment", and its social and legal implications. Following this line of research, as part of the Evolutionary Forensic Psychology Laboratory, I experienced the role of the investigative psychologist, attending as defensive consultant a case of suspected maternal infanticide. Applying the methodology of evolutionary forensic psychology, I conducted, with my supervisor, an interdisciplinary research between forensic psychobiology and legal medicine, aiming to verify the validity of tympanic and rectal temperature in estimating the time of death. I suggest that the results of this research had relevant consequences both in medico-legal and investigative domain but, above all, our outcomes brought to light a number of methodological errors, that are systematically made in our country during the crime scene investigation and the rescuing in outdoor conditions. According to these findings, I have analyzed the European Guidelines for resuscitation in wild conditions, and I took in exam what happens in the practice in our country. Finally I present representative cases, where the time of death was a crucial data, but its erroneous interpretations led to controversial verdicts. The sexual presence model Introduction to the concept of presence Presence is defined as a psychological state or subjective perception causing an individual to give into the illusions created by a computerizing system., it’s a real feeling of been immersed in a virtual environment, mediated by emotional states and biological predispositions. In the practice, it is very important to define and measure the feeling of presence, since Virtual Reality is used to for a large number of purpose. Most recent research show how useful virtual reality is in medical context, both in diagnosis and treatment assessments. According to this, here is presented a special kind of the feeling of presence, the sexual presence, which describes the particular psychological cognitive and physical feeling generate by the experience of sexuality through different media, as erotic movies or chat-line. Aim of the theory To define and understanding sexual presence is crucial to maximize and recall this feeling in an experimental context. In fact, virtual reality is a powerful tool to assess sexual fantasies and interests in individual. Especially with child molesters, and sexual offenders. To get the highest level of presence, which integrates, the users need as much identification as possible inside the virtual system, which should be provided by the developer through a convincing and controlled motor and perceptual illusion. For all these reasons, this work aims to identify the features of sexual presence, and how to induce it in an experimental situation. Main aspects of the sexual presence model Sexual presence is an evolutionary phenomenon featured by motivational emotional and physical feelings, that an individual experiences when exposed to internal or external stimuli, like erotic movies, on-line erotic chat and most of all, sexual fantasies. Sexual presence arises from an adequate combination of form and contents, and is strictly related to sexual arousal and sexual behavior. Following Riva and colleagues (2011) this work identified three sub-processes of sexual presence: proto, core and extended presence, which are deeply connected, and represent both in conscious and in unconscious behaviors and in intents that features sexual presence, and they differ from male and female. This three level model should be well-known when we need to induce sexual presence in experimental context. Thus to maximize sexual presence it is important to identified the erotic imagery features for each participant, and to develop a virtual environment which is significant to the participant. Conclusion This model could be particularly useful in the study of paraphilias and sexual behavior disordered using virtual reality system. In fact, at the present time, the research team I worked with at the Philippe-Pinel Institute, is applying this model in the study of evolutionary hypothesis on rape. Mothers Who Kill Their Offspring: Testing Evolutionary Hypothesis in a 110-case Italian Sample Introduction and aim The killing of a child by own biological mother has occurred in our species since its origin, most probably in every culture and every population. According to evolutionary theory, the killing of offspring by its own mother may, under certain conditions, represent an evolved behavioural pattern that increases the reproductive fitness of the mother. This research aimed to identify incidents of mothers in Italy killing their own children, verifying if neonaticide (killings of children within the first day of life), infanticide (killing of children within the first year of life), and filicide (killing of children after the first year of life) can be objectively distinguished by psychobiological profiles that might help to prevent them, and testing an adaptive evolutionary hypothesis to explain their occurrence. Methods 110 cases of mothers killing 123 of their own offspring from 1976 to 2010 were analyzed. Each case was classified using 13 dichotomic (yes/no) variables. Descriptive statistics and hierarchical cluster analysis were performed both for cases and variables, and significant differences between clusters were analyzed. Results: The Italian sample of neonaticides was found to satisfy most evolutionary predictions for an evolved behavioral, emotional and motivational pattern to increase fitness, showing a consistent profile for the offending mothers. All neonaticide cases fall in a single cluster, distinct from all other cases. Infanticide and filicide, on the contrary, do not significantly differ according to the variables measured (marital status, conditions of the body, mothers age, violent killing, other sons, psychopathology, economical condition, suicide, nationality). The common profile of mothers who have committed infanticide or filicide includes psychopathology, suicide or attempted suicide after killing their children, violent killing of their victims, and no attempt to conceal the victims’ bodies. These results suggest that maternal infanticide and filicide represent an improper functioning of adaptation, and their profile are much more variable than those of neonaticide offenders. Conclusion: Our study confirms that only neonaticide is an adaptive reproductive disinvestment, possibly evolved in the remote past, to increase the biological fitness of the mother by eliminating an unwanted newborn and preserving resources for future offspring born in better conditions. I here show that Neonaticide is clearly distinct from infanticide and filicide and therefore should be approached, prevented, and judged differently in penal assessment. Why mothers kill newborn: a focus on Italian sample Introduction and aims In the light of the results just presented, it has been defined deeply the phenomenon of neonaticide in our country. In line with the literature, our previous outcomes show that neonaticidal mothers are young women, in bad socio-economical situation, who can’t grow their offspring, due to a so defined “reproductive comprehensive instinct”. The socio-biological profile of these women seems very similar to those who decide to have an abortion: renounce to a pregnancy, in this case, doesn’t mean to go against the reproductive instinct, but preserveenergy and resources for a future pregnancy. Here we compared the profiles of neonaticidal mothers and women who decide to interrupt their pregnancy, in order to identify risk factors and contribute to the prevention of this phenomena. Methods 35 cases of neonaticide were analyzed. Each case was classified using 7 main dichotomic variables. To analyze possible risk factors, all data have been normalized, based on the actual frequency of the reference populations, in order to have comparable values, according to ISTAT 2002. Results This study shows that neonaticide and abortion share similar traits, especially concerning the young age of the women. The profile of these women “at risk” suggests that they are 1) normally at their first birth, 2) usually very young with 3) a great residual reproductive potential and (4) immigrated from another country. Conclusion The results here presented might have important implications in therapeutic assessment, as the identification of risk factors, to offer and promote adequate socio-psychological support to at risk future mothers. Evaluation of tympanic and rectal temperature measurements to estimate the time of death in accidents in cold water Introduction and aims The reliable measurement of core deep body temperature is fundamental to estimate the time of death (TOD) in Hessnge nomogram. The golden standard is measuring through rectal or oesophagus probe. Recently infrared tympanic thermometers (ITT), have substituted in some cases the golden standard. We assisted, as defense consultants, a case of suspect maternal infanticide, where the emergency service revealed a deep temperature of 24.9° C with ITT on a female victim of 2 years old, immersed in a 18° C river. The ITT estimated time of death, which seemed to be the only strong evidence against the mother, was in contrast with the predictions from most other biological and thanatological evidences (bloodgas analysis and myocardium electric activity). I could ascertain that according to the psycho-biological profile, the mother had no motive to kill her daughter. To validate the TOD evidence, this work aimed to provide a reliable correlation between the golden standard and infrared tympanic temperature to be eventually used in this and future cases of TOD measurements in accidents occurring in cold water. Methods To compare the ITT and the rectal probe temperature measurements, we tested laboratory rats, in three different conditions: dry alive, immersed alive in 18C° water, and immersed dead (by cervical dislocation) in 18°C water. To sample infrared temperature, we used 3 infrared thermometers. Genius 3000 A (used in this forensic case, 2 samples) and Genius 2 (the most popular at present in Italian emergency services). The rectal temperature was assessed using a rectal probe connected to a monitor Propaq. We also tested the accuracy of ITT, recording body temperatures on a human volunteer before during and after exposing its right ear to 3 minutes running water at 18°C and subsequently dried. Results The Genius 2 stopped registering at 33°C and never resumed recording following the first measurement after the rat was submersed in water. This observation was a posteriori confirmed in the user manual, which stated that this thermometer stopped reading below 33°C. When the rats were submerged in the 18°C running water, the rectal temperature began to decline steadily. The tympanic temperature recorded with Genius 3000A, in contrast, dropped sharply from 34°C to 24°C after the rats were submerged alive in the water. After their deaths, the rectal temperatures continued to decline steadily without major variations, while the tympanic temperature fluctuated above water temperature. On the human volunteer ITT measures immediately fell under 19C°, while the whole body temperature, remained unchanged at 36.5C°. ITT measurements recovered the subject correct body temperature after 33 minutes from water exposure. Conclusion In water-related accidents, such as near drowning, infrared ear thermometry is not a suitable method to measure the actual deep body temperature. Further, confirming these results, the temperature readings of the ITT device provide unreliable measurements of the core temperature. This inaccuracy could lead to inappropriate medical decisions, and thus, we suggest ITT measurements should not be utilised for such cases. Moreover, the use of the ITT Genius 2 is not recommended in emergency settings, especially in case of hypothermia due to his its incapacity to register under 33 C°. Errors, Guidelines and Remarks: what happens in the practice? Introduction and aims The results of previous study left a lot of unanswered questions. The bulk of knowledge necessary to diagnosis of the time of death, known as thanatology, is a multidisciplinary field of study, that includes forensic pathology to biology, through chemistry, physics and also forensic entomology., Assessing the victims time of death is a crucial point in forensic practice: it allows investigators to clarify the last hours alive of the victims, it also helps to point out the causes of death and, moreover, it’s crucial to substantiate suspicious alibis. Nevertheless, before becoming a crime scene, the environment and setting where a body is found, is a place where someone need to be rescued and treated by medical assistance, and this interferes with thanatological requirements. Here we aim to analyze what happens in the forensic and medico-legal practice in our country. Methods We have analyzed the European guidelines for resuscitation in wild conditions as hypothermia and drowning in cold water, with a focus on what are the suggestions for estimating the core temperature, both for the resuscitation procedure and the estimation of the time of death. Then we took in consideration what happens in Italian emergency services and which procedures, if any, they implement in the described conditions. Those data were found on the Hospital’s websites, in our Country. Finally, we have examined some relevant cases, taken from the analysis of specialized books and from the archives of major newspapers that have followed the penal processes reported, where the investigation of the crime scene and the estimation of the time of death were decisive to solve the crime. Results The European guidelines for resuscitation are very precise concerning the treatment for a patient affected by injuries due to hypothermia or drowning. But they are not that specific for what concern the use of a particular method to register the core temperature. In the forensic practice the methodology to estimate the TOD is heterogeneous. In Italy, the guidelines to resuscitation are provided just at local level, and it’s not even mandatory to have a temperature recording device on the ambulance. Conclusion We found out that procedural mistakes and lack of univocal rules in the practice have led to controversial outcomes in legal processes. Our work urges further studies regarding the techniques to estimate the post- mortem period, and suggests an adequate training for the rescue teams members, to provide the best care and to preserve such important evidence as TOD. General Conclusions In this thesis I’ve explored the applications of evolutionary psychology in the forensic practice, outlining the role of the investigative psychologist. The research outcomes might have both theoretical and practical implications. First, It has been described for the first time the sexual presence, which is a phenomena which might be involved in the assessment of paraphilias and violent behavior with virtual reality. Second, it has been found that maternal neonaticide, in our species, has an evolutionary cause, and the neonaticidal woman profile is different from infanticidal and filicide ones. These suggestions have relevant effects in the investigation phase, in correctional assessment, and also in the definitions of preventive measurement targeted to at-risk future mothers. Third, collaborating as consultant in a case of suspect infanticide, I found that the tympanic temperature, very used in the practice, is not a valuable measure to assess the time of death in extreme outdoor conditions, where the body core temperature is essential. In light of these results, it has been noticed the lack of regulations in our country about the estimating of TOD, and I provide suggestions to improve medico –legal and resuscitation actions in the forensic practice. These studies show the versatility and the practical value of evolutionary psychology in the forensic domain. In fact, the most important outcome of this work is to demonstrate how the techniques and theories learned and explored during three PhDs years, have important applications in the clinical, criminological and forensic practice, and how it could be important to carry on researches in evolutionary forensic psychology, due to its social implications

Regulation 61-16 minimum standards for licensing hospitals and institutional general infirmaries

The regulations clearly define important terms, licensing procedures, and general management information for hospitals and institutional general infirmaries in South Carolina. These facilities are required to follow licensure laws as outlined in Section 44-7-260 of the Code of Laws of South Carolina (1976)