Automated Stand-alone Surgical Safety Evaluation for Laparoscopic Cholecystectomy (LC) using Convolutional Neural Network and Constrained Local Models (CNN-CLM)

In this golden age of rapid development surgeons realized that AI could contribute to healthcare in all aspects, especially in surgery. The aim of the study will incorporate the use of Convolutional Neural Network and Constrained Local Models (CNN-CLM) which can make improvement for the assessment of Laparoscopic Cholecystectomy (LC) surgery not only bring opportunities for surgery but also bring challenges on the way forward by using the edge cutting technology. The problem with the current method of surgery is the lack of safety and specific complications and problems associated with safety in each laparoscopic cholecystectomy procedure. When CLM is utilize into CNN models, it is effective at predicting time series tasks like identifying the sequence of events in the Laparoscopic Cholecystectomy (LC). This study will contribute to show the effectiveness of CNN-CLM approach on laparoscopic cholecystectomy, which will frequently focus on surgical computer vision analysis of surgical safety and related applications. The method of study is deep learning based CNN-CLM to better detect nominal safety as well as unsafe practices around the critical view of safety and AI-based grading scale. The general design flow of AI-recognition of surgical safety is firstly collecting safety surgical videos for frame segmenting and phase according to the image context by surgeon reviewer by CNN-CLM. For this advance research, the dataset is splatted into three main parts where 70% of which is used for training, 15% of which is used for testing and the rest for the cross validation, to achieve the accuracy up to 98.79% of this specific research.  For result part, different metrics of CNN-CLM to evaluate the performance of the proposed model of safety in surgery. The study uses one of the top three performing methods CNN-CLM for the evaluation yields and anatomical structures in laparoscopic cholecystectomy surgery

Vida política em assentamentos rurais no Estado do Amazonas: um estudo sobre a configuração do poder local

Luta-se a muito tempo no Brasil, pela implantação de uma Reforma Agrária funcional, onde as relações de trabalho no campo não sejam mais precárias, não havendo acordos coletivos conseguidos a duras penas, dentre outros aspectos que torna a questão agrária tão importante para a sociedade. A organização econômica e social vigente no Brasil que começou a ser delineada há pouco mais de meio século, impõe aos brasileiros uma trajetória de sofrimentos, marcada pelo binômio lutar e morrer . O viver, nesse aspecto, se caracteriza pela busca de boas condições econômicas e sociais, ou seja, a vontade de se dispor a condições dignas de vida. Há aproximadamente sessenta anos, algumas convulsões sociais provocaram certas acomodações e reordenamentos na cúpula da estrutura de classes da sociedade brasileira. Todavia, na década de 70, iniciaram-se os projetos de assentamentos na região norte, com o incentivo de outras regiões, ocorrendo dessa maneira a criação de instituições, como o INCRA Instituto Nacional de Colonização e Reforma Agrária, que atualmente ainda possui papel fundamental e significativo no que diz respeito a política de assentamento rural. No entanto, a iniciação aos projetos de assentamentos e colonização da região norte (que ocorreu no mesmo período), culminou com a descoberta de singularidades e especificidades presentes em diferentes estados, aumentando dessa forma, o estudo e a diferenciação das regiões para a obtenção de resultados significativos e políticas fundiárias mais elaboradas de acordo com essas diversidades. Com essas observações, adicionados ao conhecimento sobre o assunto, o objetivo desse projeto é uma pesquisa sobre a vida política em assentamentos rurais no Estado do Amazonas, e um estudo aprofundado sobre a configuração do pode local nos assentamentos dos municípios de Silves, Maués, Anori, Parintins, Uarini, Manicoré e Tefé.CNP

Classification single-lead ECG by using conventional neural network algorithm

Cardiac disease, including atrial fibrillation (AF), is one of the biggest causes of morbidity and mortality in the world, accounting for one third of all deaths. Cardiac modelling is now a well-established field.  The Convolutional Neural Network (CNN) algorithm offer a valuable way of gaining insight into the dynamic behaviors of the heart, in normal and pathological conditions. Great efforts have been put into modelling the ventricles, whilst the atria have received less focus. This research therefore concentrates on developing models of the heart ECG atria using deep learning. The research developed an experimental result on MIT-BIH dataset for modelling myocyte electrophysiology and excitation waves in 1D & 2D tissues. It includes optimizations such as adaptive stimulus protocols. As examples of application, it is used to investigate effects of a novel anion bearing current on heart atrial excitation and the effect of remodeling on atrial myocyte electrical heterogeneity. A computationally efficient CNN anatomically based model of the heart atria is constructed. The 3D-CNN model includes heterogeneous, biophysically detailed electrophysiology and conduction anisotropy. The full model activates in 121 ms in heart rhythm, in close agreement with clinical ECG data. The model is used, with the toolkit, to investigate the function effects of S140G mutation in MIT-BIH dataset which is associated with familial. The 3D-CNN model forms the core of a boundary element model of the P-wave Body Surface Potential (BSP). The CNN model incorporates representations of the heart blood masses. Generated ECGs show qualitative agreement with clinical data. Their morphology is as expected for a healthy person, with a lead duration of 103 ms. The CNN model is used to verify an existing algorithm for focal atrial tachycardia location and in providing explanation for a novel clinical phenomenon, using CNN with 99.27% accuracy. Models of the human atria and body surface potential are constructed. The models are validated against both experimental and clinical data. These models are suitable to use as the platform for further research

An optimized deep learning model for optical character recognition applications

The convolutional neural networks (CNN) are among the most utilized neural networks in various applications, including deep learning. In recent years, the continuing extension of CNN into increasingly complicated domains has made its training process more difficult. Thus, researchers adopted optimized hybrid algorithms to address this problem. In this work, a novel chaotic black hole algorithm-based approach was created for the training of CNN to optimize its performance via avoidance of entrapment in the local minima. The logistic chaotic map was used to initialize the population instead of using the uniform distribution. The proposed training algorithm was developed based on a specific benchmark problem for optical character recognition applications; the proposed method was evaluated for performance in terms of computational accuracy, convergence analysis, and cost

Wise versus vertical mastopexy pattern skin-reducing mastectomy with immediate breast reconstruction: systematic review and meta-analysis

Background: This study compares postoperative outcomes of Wise and vertical mastopexy pattern skin-reducing/skin-sparing masctomy, hypothesizing that incision choice affects cosmetic outcomes and complication rates. Methods: A systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching PubMed, MEDLINE, Embase, Web of Science, and StarPlus Library. Included studies documented skin-sparing mastectomy using Wise or vertical mastopexy patterns with immediate reconstruction. The primary outcome is total mastectomy flap necrosis. The secondary outcomes are major/minor necrosis, infection, hematoma, seroma, and wound complications. Bayesian and frequentist generalized linear mixed models were used for the meta-analysis, including studies with 0 events. Results: Sixty-six studies were identified, with 39 included in the meta-analysis, comprising 1954 patients and 2311 breast reconstruction cases. The Wise group had a higher rate of mastectomy flap necrosis (14.2%; 95% confidence interval: 10%–20%; I² = 83%) compared with the vertical group (7.8%; 95% confidence interval: 5%–12%; I² = 0%) (P < 0.05). No significant differences were found in other domains. Subgroup analysis favored vertical mastopexy for wound-related complications (P = 0.04). Conclusions: The Wise pattern shows significantly higher mastectomy flap necrosis than the vertical pattern. However, there were no significant differences in major necrosis, minor necrosis, infection, hematoma, or seroma. Future studies should focus on larger, high-quality randomized controlled trials to better understand the impact of incision techniques on postoperative outcomes

Male involvement interventions and improved couples’ emotional relationships in Tanzania and Zimbabwe: ‘When we are walking together, I feel happy’

Male involvement in maternal and child health is recognised as a valuable strategy to improve care-seeking and uptake of optimal home care practices for women and children in low- and middle-income settings. However, the specific mechanisms by which involving men can lead to observed behaviour change are not well substantiated. A qualitative study conducted to explore men’s and women’s experiences of male involvement interventions in Tanzania and Zimbabwe found that, for some women and men, the interventions had fostered more loving partner relationships. Both male and female participants identified these changes as profoundly meaningful and highly valued. Our findings illustrate key pathways by which male involvement interventions were able to improve couples’ emotional relationships. Findings also indicate that these positive impacts on couple relationships can motivate and support men’s behaviour change, to improve care-seeking and home care practices. Men’s and women’s subjective experiences of partner relationships following male involvement interventions have not been well documented to date. Findings highlight the importance of increased love, happiness and emotional intimacy in couple relationships – both as a wellbeing outcome valued by men and women, and as a contributor to the effectiveness of male involvement interventions

Risk factors associated with short-term complications in mandibular fractures: the MANTRA study—a Maxillofacial Trainee Research Collaborative (MTReC)

Abstract Introduction Complications following mandibular fractures occur in 9–23% of patients. Identifying those at risk is key to prevention. Previous studies highlighted smoking, age and time from injury to presentation as risk factors but rarely recorded other possible confounders. In this paper, we use a collaborative snapshot audit to document novel risk factors and confirm established risks for complications following the treatment of mandibular fractures. Methods The audit was carried out by 122 OMFS trainees across the UK and Ireland (49 centres) over 6 months, coordinated by the Maxillofacial Surgery Trainees Research Collaborative. Variables recorded included basic demography, medical and social history, injury mechanism and type, management and 30-day outcome. Results Nine hundred and forty-seven (947) patients with fractured mandibles were recorded. Surgical management was carried out in 76.3%. Complications at 30 days occurred 65 (9%) of those who were managed surgically. Risk factors for complications included male sex, increasing age, any medical history, increasing number of cigarettes smoked per week, increasing alcohol use per week, worse oral hygiene and increased time from injury to presentation. Discussion We have used a large prospective snapshot audit to confirm established risk factors and identify novel risk factors. We demonstrate that time from injury to presentation is confounded by other indicators of poor health behaviour. These results are important in designing trial protocols for management of mandibular fractures and in targeting health interventions to patients at highest risk of complications. </jats:sec

Chlorhexidine versus povidone–iodine skin antisepsis before upper limb surgery (CIPHUR) : an international multicentre prospective cohort study

Introduction Surgical site infection (SSI) is the most common and costly complication of surgery. International guidelines recommend topical alcoholic chlorhexidine (CHX) before surgery. However, upper limb surgeons continue to use other antiseptics, citing a lack of applicable evidence, and concerns related to open wounds and tourniquets. This study aimed to evaluate the safety and effectiveness of different topical antiseptics before upper limb surgery. Methods This international multicentre prospective cohort study recruited consecutive adults and children who underwent surgery distal to the shoulder joint. The intervention was use of CHX or povidone–iodine (PVI) antiseptics in either aqueous or alcoholic form. The primary outcome was SSI within 90 days. Mixed-effects time-to-event models were used to estimate the risk (hazard ratio (HR)) of SSI for patients undergoing elective and emergency upper limb surgery. Results A total of 2454 patients were included. The overall risk of SSI was 3.5 per cent. For elective upper limb surgery (1018 patients), alcoholic CHX appeared to be the most effective antiseptic, reducing the risk of SSI by 70 per cent (adjusted HR 0.30, 95 per cent c.i. 0.11 to 0.84), when compared with aqueous PVI. Concerning emergency upper limb surgery (1436 patients), aqueous PVI appeared to be the least effective antiseptic for preventing SSI; however, there was uncertainty in the estimates. No adverse events were reported. Conclusion The findings align with the global evidence base and international guidance, suggesting that alcoholic CHX should be used for skin antisepsis before clean (elective upper limb) surgery. For emergency (contaminated or dirty) upper limb surgery, the findings of this study were unclear and contradict the available evidence, concluding that further research is necessary