Exploring the utility of assistive artificial intelligence for ultrasound scanning in regional anesthesia

This work was funded by Intelligent Ultrasound Limited (Cardiff, UK). Data from this study were included in medical device regulatory approval submissions in the USA.Introduction: Ultrasound-guided regional anesthesia (UGRA) involves the acquisition and interpretation of ultrasound images to delineate sonoanatomy. This study explores the utility of a novel artificial intelligence (AI) device designed to assist in this task (ScanNav Anatomy Peripheral Nerve Block; ScanNav), which applies a color overlay on real-time ultrasound to highlight key anatomical structures. Methods: Thirty anesthesiologists, 15 non-experts and 15 experts in UGRA, performed 240 ultrasound scans across nine peripheral nerve block regions. Half were performed with ScanNav. After scanning each block region, participants completed a questionnaire on the utility of the device in relation to training, teaching, and clinical practice in ultrasound scanning for UGRA. Ultrasound and color overlay output were recorded from scans performed with ScanNav. Experts present during the scans (real-time experts) were asked to assess potential for increased risk associated with use of the device (eg, needle trauma to safety structures). This was compared with experts who viewed the AI scans remotely. Results: Non-experts were more likely to provide positive and less likely to provide negative feedback than experts (p=0.001). Positive feedback was provided most frequently by non-experts on the potential role for training (37/60, 61.7%); for experts, it was for its utility in teaching (30/60, 50%). Real-time and remote experts reported a potentially increased risk in 12/254 (4.7%) vs 8/254 (3.1%, p=0.362) scans, respectively. Discussion: ScanNav shows potential to support non-experts in training and clinical practice, and experts in teaching UGRA. Such technology may aid the uptake and generalizability of UGRA. TRIAL REGISTRATION NUMBER: NCT04918693.Publisher PDFPeer reviewe

Utilization of Assay Performance Characteristics to Estimate Hemoglobin A1c Result Reliability

BACKGROUND: Allowable total error (TE(a)) goals for hemoglobin (Hb) A(1c) require minimal assay imprecision and bias and implementation of a robust QC monitoring program. Here, we compare the combined influence on the risk of reporting unreliable results of TE(a) goals, a routine QC practice, and assay performance characteristics of 6 Hb A(1c) instruments across 4 academic medical centers. METHODS: The CLSI protocols EP-5 and EP-9 were applied to investigate Hb A(1c) result imprecision and bias on the Variant II Turbo and Variant II (Bio-Rad), G8 (Tosoh), Capillarys 2 Flex Piercing (Sebia), COBAS Integra 800 (Roche), and DCA Vantage (Siemens). Patient-weighted σ values and the risk of reporting unreliable Hb A(1c) results were determined for each assay at TE(a) specifications of 5%, 6%, and 7%. RESULTS: A large range of patient-weighted σ values spanning 0.5 orders of magnitude at a 6% TE(a) was observed. Although imprecision for all instruments was <3%, bias impacted the majority of the σ changes observed. Estimates for reporting unreliable results varied almost 500-fold based on analytical performance alone. CONCLUSIONS: Considerable differences in the probability of reporting unreliable Hb A(1c) results between different NGSP (formerly the National Glycohemoglobin Standardization Program)-certified platforms were observed. At a 6% TE(a), our study indicates all but the Capillarys 2 Flex Piercing requires that the maximum affordable QC be run. Risk estimates for individual laboratories' Hb A(1c) methods can be used to assess QC practices and residual risk of an unreliable Hb A(1c) result

Excavations at Tell Fadous-Kfarabida:Preliminary report on the 2106 season of excavations

This report presents the main results of the final season of excavations in 2016at Tell Fadous-Kfarabida, located on the north Lebanese coast 2 km south of Batroun.Excavations focused on four areas. In Area II we worked only in Squares 310/295and parts of 305/295, where the excavations in 2015 did not reach a satisfactory end. We continued to excavate in and under the northern rooms of Building 4 (Phase III, Early Bronze Age III) and reached the earlier Phases II (Early Bronze Age II) and Phase I (Chalcolithic) in very limited areas. In Areas III and IV, we continued the work begun in 2014 and 2015. Area III is located on the southern slope of the tell. In 2016, work mainly focused on exposing domesticarchitecture from Phase III (Early Bronze Age III). Area IV is situated at the eastern edge of the site, where we continued the investigation of the Early Bronze Age fortification system with a monumental gate (Phase III, Early Bronze Age III). Area V, situated in the northcentral part of the tell, was newly opened in 2016. Here remains of substantial buildings, attributable to Phase III (Early Bronze Age III) were uncovered. In addition to the general overviews of the main features exposed in the different areas during the 2016 season, this report contains specialist reports on ceramic material and small finds from various phases as well as progress reports of ongoing archaeozoological and isotopic investigations