Automatic Assessment of Infant Face and Upper-Body Symmetry as Early Signs of Torticollis

We apply computer vision pose estimation techniques developed expressly for the data-scarce infant domain to the study of torticollis, a common condition in infants for which early identification and treatment is critical. Specifically, we use a combination of facial landmark and body joint estimation techniques designed for infants to estimate a range of geometric measures pertaining to face and upper body symmetry, drawn from an array of sources in the physical therapy and ophthalmology research literature in torticollis. We gauge performance with a range of metrics and show that the estimates of most these geometric measures are successful, yielding strong to very strong Spearman's $\rho$ correlation with ground truth values. Furthermore, we show that these estimates, derived from pose estimation neural networks designed for the infant domain, cleanly outperform estimates derived from more widely known networks designed for the adult domai

Computer Vision to the Rescue: Infant Postural Symmetry Estimation from Incongruent Annotations

Bilateral postural symmetry plays a key role as a potential risk marker for autism spectrum disorder (ASD) and as a symptom of congenital muscular torticollis (CMT) in infants, but current methods of assessing symmetry require laborious clinical expert assessments. In this paper, we develop a computer vision based infant symmetry assessment system, leveraging 3D human pose estimation for infants. Evaluation and calibration of our system against ground truth assessments is complicated by our findings from a survey of human ratings of angle and symmetry, that such ratings exhibit low inter-rater reliability. To rectify this, we develop a Bayesian estimator of the ground truth derived from a probabilistic graphical model of fallible human raters. We show that the 3D infant pose estimation model can achieve 68% area under the receiver operating characteristic curve performance in predicting the Bayesian aggregate labels, compared to only 61% from a 2D infant pose estimation model and 60% from a 3D adult pose estimation model, highlighting the importance of 3D poses and infant domain knowledge in assessing infant body symmetry. Our survey analysis also suggests that human ratings are susceptible to higher levels of bias and inconsistency, and hence our final 3D pose-based symmetry assessment system is calibrated but not directly supervised by Bayesian aggregate human ratings, yielding higher levels of consistency and lower levels of inter-limb assessment bias

Comparison of Clinician Suspicion Versus a Clinical Prediction Rule in Identifying Children at Risk for Intra‐abdominal Injuries After Blunt Torso Trauma

ObjectivesEmergency department (ED) identification and radiographic evaluation of children with intra‐abdominal injuries who need acute intervention can be challenging. To date, it is unclear if a clinical prediction rule is superior to unstructured clinician judgment in identifying these children. The objective of this study was to compare the test characteristics of clinician suspicion with a derived clinical prediction rule to identify children at risk of intra‐abdominal injuries undergoing acute intervention following blunt torso trauma.MethodsThis was a planned subanalysis of a prospective, multicenter observational study of children (50% prior to knowledge of abdominal computed tomography (CT) scanning (if performed). Intra‐abdominal injuries undergoing acute intervention were defined by a therapeutic laparotomy, angiographic embolization, blood transfusion for abdominal hemorrhage, or intravenous fluid administration for 2 or more days in those with pancreatic or gastrointestinal injuries. Patients were considered to be positive for clinician suspicion if suspicion was documented as ≥1%. Suspicion ≥ 1% was compared to the presence of any variable in the prediction rule for identifying children with intra‐abdominal injuries undergoing acute intervention.ResultsClinicians recorded their suspicion in 11,919 (99%) of 12,044 patients enrolled in the parent study. Intra‐abdominal injuries undergoing acute intervention were diagnosed in 203 (2%) patients. Abdominal CT scans were obtained in the ED in 2,302 of the 2,667 (86%, 95% confidence interval [CI] = 85% to 88%) enrolled patients with clinician suspicion ≥1% and in 3,016 of the 9,252 (33%, 95% CI = 32% to 34%) patients with clinician suspicion  50% previamente a conocer la tomografía computarizada (TC) abdominal (si fue realizada). La LIA con necesidad de intervención urgente se definió como laparotomía terapéutica, embolización angiográfica, transfusión de sangre por hemorragia intrabdominal o administración de fluidos intravenosos durante 2 o más días en aquéllos con lesiones pancreáticas o gastrointestinales. Los pacientes se consideraron positivos para la sospecha clínica si la sospecha se documentó como ≥1%. La sospecha > 1% se comparó con la presencia de cualquier variable en la regla de predicción para la identificación de niños con LIA con necesidad de una intervención urgente.ResultadosLos clínicos documentaron su sospecha en 11.919 (99%) de los 12.044 pacientes incluidos en el estudio original. La LIA con necesidad de intervención urgente se diagnosticó en 203 (2%) pacientes. Las TC abdominales se obtuvieron en el SU en 2.302 de los 2.667 pacientes (86%, IC95% = 85% a 88%) incluidos con sospecha clínica ≥1%; y en 3.016 de los 9.252 pacientes (33%, IC95% = 32% a 34%) con sospecha clínica < 1%. La sensibilidad de la regla de predicción para LIA con necesidad de intervención aguda fue mayor que la sospecha clínica ≥1% (197 de 203, 97,0%, IC95% = 93,7% a 98,9%, frente a 168 de 203, 82,8%, IC95% = 76,9% a 87,7%, respectivamente; diferencia de 14,2%, IC95% = 8,6% a 20,0%). La especificidad de la regla de predicción, sin embargo, fue menor que la sospecha clínica (4,979 de los 11.716, 42,5%, IC95% = 41,6% a 43,4%, frente a 9,217 de los 11.716, 78,7%, IC95% = 77,9% a 79,4%, respectivamente; diferencia de –36,2%, IC95% = –37,3% a –35,0%). Treinta y cinco de los pacientes con sospecha clínica < 1% (0,4%, IC95% = 0,3% a 0,5%) tuvieron LIA con necesidad de intervención urgente.ConclusionesLa regla de predicción clínica derivada tuvo una sensibilidad mayor de forma significativa, pero menor especificidad que la sospecha clínica para la identificación de niños con necesidad de una intervención urgente. La mayor especificidad de la sospecha clínica, sin embargo, no se tradujo en la práctica clínica, ya que los clínicos obtuvieron más frecuentemente TC abdominales en los pacientes que consideraron de muy bajo riesgo. Si se validase, esta regla de predicción puede ayudar en la toma de decisiones clínicas sobre el uso de TC abdominal en los niños con traumatismo torácico cerrado.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/113736/1/acem12739.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/113736/2/acem12739_am.pd

Explaining racial disparities in incidence of and survival from out-of-hospital cardiac arrest

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/55494/1/galea_explaining racial disparities_2007.pd

Merdeka Belajar Merdeka Mengajar

Kebijakan pemerintah “Merdeka Belajar, Kampus Merdeka” tentu menimbulkan respon tersendiri bagi para dosen selaku akademisi bagaimana menyikapi, merencanakan, menyusun dan mengimplementasikan sistem dan model belajar yang paling sesuai dengan kebijakan tersebut. Dan di buku Antologi inilah akan dijumpai berbagai pandangan, pemikiran, dan juga mungkin gambaran usulan untuk mengimplementasikan kebijakan MBKM di era informasi teknologi yang sangat cepat berubah dewasa ini. Sebagai pendidik profesional, para dosen tentu memiliki kiat dan cara tersendiri untuk bisa menghasilkan output lulusan peserta didik yang benar-benar sesuai dengan tujuan dan target kebijakan MBKM tersebu

Are We Doing Enough to Reduce Ionizing Radiation Exposure in Children?: An Analysis of Current Approaches to Pediatric Appendicitis Imaging at a Major Urban Medical Center.

OBJECTIVE: The aim of this study was to evaluate current imaging approaches in children with suspected appendicitis (AP) in the pediatric emergency department (ED) of a major urban medical center. METHODS: Children aged 6 to 18 years who presented to a pediatric ED in 2016 with possible AP were identified by a keyword search. Charts were reviewed for the following: age, sex, time of evaluation, imaging study, results of imaging study, disposition, and outcome. RESULTS: We calculated mean values and SD for continuous data. Initially, 503 charts were identified. Of these 503, 292 children were identified as having possible AP. Mean age was 10.7 years (SD, 2.7); 50.6% presented between 5:00 PM and 8:00 AM the next morning. Of the 287 US studies performed, 114 (39.7%) were definitively positive or negative. Of these, 46 (16.0%) were negative for AP and 68 (23.7%) were positive. There were 173 (60.3%) ultrasounds that were equivocal. Computed tomography scans were performed in 41 (13.9%) of the total 292 patients, and 2 (0.7%) of the 292 received magnetic resonance imaging. Patient dispositions were as follows: discharged home, 163 (55.8%); admitted for appendectomy, 69 (23.6%); admitted for observation, 37 (12.7%); and extended observation in ED, 10 (3.4%). There were 83 (28.4%) total surgical and interventional radiology cases and 209 (71.6%) nonsurgical cases. Of the 81 appendectomies, 79 (97.5%) had an abnormal appendix, and 2 (2.5%) had no AP. Of the 79 abnormal appendices, 22 (27.8%) were perforated, 55 (69.6%) were not, and 2 (2.6%) were unclear. CONCLUSIONS: Computed tomography scans were performed in 13.9% of patients with suspected AP. The overall AP rate was 28.4%. We plan to increase the use of magnetic resonance imaging and other modalities to reduce overall computed tomography usage