Exploring vision transformers for classifying early Barrett's dysplasia in endoscopic images: A pilot study on white-light and narrow-band imaging.

Background and Aim: Various deep learning models, based on convolutional neural network (CNN), have been shown to improve the detection of early esophageal neoplasia in Barrett's esophagus. Vision transformer (ViT), derived from natural language processing, has emerged as the new state-of-the-art for image recognition, outperforming predecessors such as CNN. This pilot study explores the use of ViT to classify the presence or absence of early esophageal neoplasia in endoscopic images of Barrett's esophagus. Methods: A BO dataset of 1918 images of Barrett's esophagus from 267 unique patients was used. The images were classified as dysplastic (D-BO) or non-dysplastic (ND-BO). A pretrained vision transformer model, ViTBase16, was used to develop our classifier models. Three ViT models were developed for comparison based on imaging modality: white-light imaging (WLI), narrow-band imaging (NBI), and combined modalities. Performance of each model was evaluated based on accuracy, sensitivity, specificity, confusion matrices, and receiver operating characteristic curves. Results: The ViT models demonstrated the following performance: WLI-ViT (Accuracy: 92%, Sensitivity: 82%, Specificity: 95%), NBI-ViT (Accuracy: 99%, Sensitivity: 97%, Specificity: 99%), and combined modalities-ViT (Accuracy: 93%, Sensitivity: 87%, Specificity: 95%). Combined modalities-ViT showed greater accuracy (94% vs 90%) and sensitivity (80% vs 70%) compared with WLI-ViT when classifying WLI images on a subgroup testing set. Conclusion: ViT exhibited high accuracy in classifying the presence or absence of EON in endoscopic images of Barrett's esophagus. ViT has the potential to be widely applicable to other endoscopic diagnoses of gastrointestinal diseases.

Understanding the effects of stress on the P300 response during naturalistic simulation of heights exposure.

Stress is a prevalent bodily response universally experienced and significantly affects a person's mental and cognitive state. The P300 response is a commonly observed brain behaviour that provides insight into a person's cognitive state. Previous works have documented the effects of stress on the P300 behaviour; however, only a few have explored the performance in a mobile and naturalistic experimental setup. Our study examined the effects of stress on the human brain's P300 behaviour through a height exposure experiment that incorporates complex visual, vestibular, and proprioceptive stimuli. A more complex sensory environment could produce translatable findings toward real-world behaviour and benefit emerging technologies such as brain-computer interfaces. Seventeen participants experienced our experiment that elicited the stress response through physical and virtual height exposure. We found two unique groups within our participants that exhibited contrasting behavioural performance and P300 target reaction response when exposed to stressors (from walking at heights). One group performed worse when exposed to heights and exhibited a significant decrease in parietal P300 peak amplitude and increased beta and gamma power. On the other hand, the group less affected by stress exhibited a change in their N170 peak amplitude and alpha/mu rhythm desynchronisation. The findings of our study suggest that a more individualised approach to assessing a person's behaviour performance under stress can aid in understanding P300 performance when experiencing stress.

Effect of Standardized Bundle Care and Bundle Compliance on Reducing Surgical Site Infections: A Pragmatic Retrospective Cohort Study.

BACKGROUND Care bundles for infection control consist of a set of evidence-based measures to prevent infections. This retrospective study aimed to compare surgical site infections (SSIs) from a single hospital surveillance system between 2017 and 2020, before and after implementing a standardized care bundle across specialties in 2019. It also aimed to assess whether bundle compliance affects the rate of SSIs. MATERIAL AND METHODS A care bundle consisting of 4 components (peri-operative antibiotics use, peri-operative glycemic control, pre-operative skin preparation, and maintaining intra-operative body temperature) was launched in 2019. We compared the incidence rates of SSIs, standardized infection ratio (SIR), and clinical outcomes of surgical procedures enrolled in the surveillance system before and after introducing the bundle care. The level of bundle compliance, defined as the number of fully implemented bundle components, was evaluated. RESULTS We included 6059 procedures, with 2010 in the pre-bundle group and 4049 in the post-bundle group. Incidence rates of SSIs (1.7% vs 1.0%, P=0.013) and SIR (0.8 vs 1.48, P<0.01) were significantly lower in the post-bundle group. The incidence of SSIs was significantly lower when all bundle components were fully adhered to, compared with when only half of the components were adhered to (0.3% vs 4.0%, P<0.01). CONCLUSIONS SSIs decreased significantly after the application of a standardized care bundle for surgical procedures across specialties. Full adherence to all bundle components was the key to effectively reducing the risk of surgical site infections.

Artificial intelligence as a teaching tool for gynaecological ultrasound: A systematic search and scoping review.

Purpose: The aim of this study was to investigate the current application of artificial intelligence (AI) tools in the teaching of ultrasound skills as they pertain to gynaecological ultrasound. Methods: A scoping review was performed. Eight databases (MEDLINE, EMBASE, EMCARE, CINAHL, Scopus, Web of Science, IEEE Xplore and ACM digital library) were searched in December 2022 using predefined keywords. All types of publications were eligible for inclusion so long as they reported the use of an AI tool, included reference to or discussion of teaching or the improvement of ultrasound skills and pertained to gynaecological ultrasound. Conference abstracts and non-English language papers which could not be adequately translated into English were excluded. Results: The initial database search returned 481 articles. After screening against our inclusion and exclusion criteria, two were deemed to meet the inclusion criteria. Neither of the articles included reported original research (one systematic review and one review article). Neither of the included articles explicitly provided details of specific tools developed for the teaching of ultrasound skills for gynaecological imaging but highlighted similar applications within the field of obstetrics which could potentially be expanded. Conclusion: Artificial intelligence can potentially assist in the training of sonographers and other ultrasound operators, including in the field of gynaecological ultrasound. This scoping review revealed however that to date, no original research has been published reporting the use or development of such a tool specifically for gynaecological ultrasound.

The Effects of Virtual and Physical Elevation on Physiological Stress During Virtual Reality Height Exposure.

Advances in virtual reality technology have greatly benefited the acrophobia research field. Virtual reality height exposure is a reliable method of inducing stress with low variance across ages and demographics. When creating a virtual height exposure environment, researchers have often used haptic feedback elements to improve the sense of realism of a virtual environment. While the quality of the rendered for the virtual environment increases over time, the physical environment is often simplified to a conservative passive haptic feedback platform. The impact of the increasing disparity between the virtual and physical environment on the induced stress levels is unclear. This article presents an experiment that explored the effect of combining an elevated physical platform with different levels of virtual heights to induce stress. Eighteen participants experienced four different conditions of varying physical and virtual heights. The measurements included gait parameters, heart rate, heart rate variability, and electrodermal activity. The results show that the added physical elevation at a low virtual height shifts the participant's walking behaviour and increases the perception of danger. However, the virtual environment still plays an essential role in manipulating height exposure and inducing physiological stress. Another finding is that a person's behaviour always corresponds to the more significant perceived threat, whether from the physical or virtual environment.

Error-related potential-based shared autonomy via deep recurrent reinforcement learning.

Objective.Error-related potential (ErrP)-based brain-computer interfaces (BCIs) have received a considerable amount of attention in the human-robot interaction community. In contrast to traditional BCI, which requires continuous and explicit commands from an operator, ErrP-based BCI leverages the ErrP, which is evoked when an operator observes unexpected behaviours from the robot counterpart. This paper proposes a novel shared autonomy model for ErrP-based human-robot interaction.Approach.We incorporate ErrP information provided by a BCI as useful observations for an agent and formulate the shared autonomy problem as a partially observable Markov decision process. A recurrent neural network-based actor-critic model is used to address the uncertainty in the ErrP signal. We evaluate the proposed framework in a simulated human-in-the-loop robot navigation task with both simulated users and real users.Main results.The results show that the proposed ErrP-based shared autonomy model enables an autonomous robot to complete navigation tasks more efficiently. In a simulation with 70% ErrP accuracy, agents completed the task 14.1% faster than in the no ErrP condition, while with real users, agents completed the navigation task 14.9% faster.Significance.The evaluation results confirmed that the shared autonomy via deep recurrent reinforcement learning is an effective way to deal with uncertain human feedback in a complex human-robot interaction task.

Diagnostic Accuracy of Artificial Intelligence (AI) to Detect Early Neoplasia in Barrett's Esophagus: A Non-comparative Systematic Review and Meta-Analysis.

Background and Aims: Artificial Intelligence (AI) is rapidly evolving in gastrointestinal (GI) endoscopy. We undertook a systematic review and meta-analysis to assess the performance of AI at detecting early Barrett's neoplasia. Methods: We searched Medline, EMBASE and Cochrane Central Register of controlled trials database from inception to the 28th Jan 2022 to identify studies on the detection of early Barrett's neoplasia using AI. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies - 2 (QUADAS-2). A random-effects model was used to calculate pooled sensitivity, specificity, and diagnostics odds ratio (DOR). Forest plots and a summary of the receiving operating characteristics (SROC) curves displayed the outcomes. Heterogeneity was determined by I 2, Tau2 statistics and p-value. The funnel plots and Deek's test were used to assess publication bias. Results: Twelve studies comprising of 1,361 patients (utilizing 532,328 images on which the various AI models were trained) were used. The SROC was 0.94 (95% CI: 0.92-0.96). Pooled sensitivity, specificity and diagnostic odds ratio were 90.3% (95% CI: 87.1-92.7%), 84.4% (95% CI: 80.2-87.9%) and 48.1 (95% CI: 28.4-81.5), respectively. Subgroup analysis of AI models trained only on white light endoscopy was similar with pooled sensitivity and specificity of 91.2% (95% CI: 85.7-94.7%) and 85.1% (95% CI: 81.6%-88.1%), respectively. Conclusions: AI is highly accurate at detecting early Barrett's neoplasia and validated for patients with at least high-grade dysplasia and above. Further well-designed prospective randomized controlled studies of all histopathological subtypes of early Barrett's neoplasia are needed to confirm these findings further.

Identification of EEG Dynamics During Freezing of Gait and Voluntary Stopping in Patients With Parkinson's Disease.

Mobility is severely impacted in patients with Parkinson's disease (PD), who often experience involuntary stopping from the freezing of gait (FOG). Understanding the neurophysiological difference between "voluntary stopping" and "involuntary stopping" caused by FOG is vital for the detection of and potential intervention for FOG in the daily lives of patients. This study characterised the electroencephalographic (EEG) signature associated with FOG in contrast to voluntary stopping. The protocol consisted of a timed up-and-go (TUG) task and an additional TUG task with a voluntary stopping component, where participants reacted to verbal "stop" and "walk" instructions by voluntarily stopping or walking. Event-related spectral perturbation (ERSP) analysis was performed to study the dynamics of the EEG spectra induced by different walking phases, including normal walking, voluntary stopping and episodes of involuntary stopping (FOG), as well as the transition windows between normal walking and voluntary stopping or FOG. These results demonstrate for the first time that the EEG signal during the transition from walking to voluntary stopping is distinguishable from that during the transition to involuntary stopping caused by FOG. The EEG signature of voluntary stopping exhibits a significantly decreased power spectrum compared with that of FOG episodes, with distinctly different patterns in the delta and low-beta power in the central area. These findings suggest the possibility of a practical EEG-based tool that can accurately predict FOG episodes, excluding the potential confounding of voluntary stopping.

How peptic ulcer disease could potentially lead to the lifelong, debilitating effects of chronic fatigue syndrome: an insight.

Chronic Fatigue Syndrome (CFS) has been defined as unexplained relapsing or persistent fatigue for at least 6 consecutive months. Immuno-inflammatory pathway, bacterial infection, and other causes play essential roles in CFS. Helicobacter pylori infection is one of the most common causes of foregut inflammation, leading to peptic ulcer disease (PUD). This study aimed to analyze the risk of CFS development between patients with and without PUD. Other related factors were also analyzed. We performed a retrospective, nationwide cohort study identifying patients with or without PUD respectively by analyzing the Longitudinal Health Insurance Database 2000 (LHID2000), Taiwan. The overall incidence of CFS was higher in the PUD cohort than in the non- PUD cohort (HR = 2.01, 95% CI = 1.75-2.30), with the same adjusted HR (aHR) when adjusting for age, sex, and comorbidities. The sex-specific PUD cohort to the non-PUD cohort relative risk of CFS was significant in both genders. The age-specific incidence of CFS showed incidence density increasing with age in both cohorts. There is an increased risk of developing CFS following PUD, especially in females and the aging population. Hopefully, these findings can prevent common infections from progressing to debilitating, chronic conditions such as CFS.

Evaluating Balance Recovery Techniques for Users Wearing Head-Mounted Display in VR.

Room-scale 3D position tracking enables users to explore a virtual environment by physically walking, which improves comfort and the level of immersion. However, when users walk with their eyesight blocked by a head-mounted display, they may unexpectedly lose their balance and fall if they bump into real-world obstacles or unintentionally shift their center of mass outside the margin of stability. This paper evaluates balance recovery methods and intervention timing during the use of VR with the assumption that the onset of a fall is given. Our experiment followed the tether-release protocol during clinical research and induced a fall while a subject was engaged in a secondary 3D object selection task. The experiment employed a two-by-two design that evaluated two assistive techniques, i.e., video-see-through and auditory warning at two different timings, i.e., at fall onset and 500ms prior to fall onset. The data from 17 subjects showed that video-see-through triggered 500 ms before the onset of fall can effectively help users recover from falls. Surprisingly, video-see-through at fall onset has a significant negative impact on balance recovery and produces similar results to those of the baseline condition (no intervention).

The impact of hand movement velocity on cognitive conflict processing in a 3D object selection task in virtual reality.

Detecting and correcting incorrect body movements is an essential part of everyday interaction with one's environment. The human brain provides a monitoring system that constantly controls and adjusts our actions according to our surroundings. However, when our brain's predictions about a planned action do not match the sensory inputs resulting from that action, cognitive conflict occurs. Much is known about cognitive conflict in 1D/2D environments; however, less is known about the role of movement characteristics associated with cognitive conflict in 3D environment. Hence, we devised an object selection task in a virtual reality (VR) environment to test how the velocity of hand movements impacts human brain responses. From a series of analyses of EEG recordings synchronized with motion capture, we found that the velocity of the participants' hand movements modulated the brain's response to proprioceptive feedback during the task and induced a prediction error negativity (PEN). Additionally, the PEN originates in the anterior cingulate cortex and is itself modulated by the ballistic phase of the hand's movement. These findings suggest that velocity is an essential component of integrating hand movements with visual and proprioceptive information during interactions with real and virtual objects.

Discordance of vancomycin minimum inhibitory concentration for methicillin-resistant Staphylococcus aureus at 2 µg/mL between Vitek II, E-test, and Broth Microdilution.

BACKGROUND: Vancomycin, the first line antibiotic for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, is often administered inappropriately when MIC is greater than 2 µg/mL, including 'susceptible' strains. This study assessed the discordance of vancomycin minimum inhibitory concentration (MIC) for methicillin-resistant Staphylococcus aureus (MRSA). METHODS: In total, 229 MRSA isolates from blood cultures collected between 2009 and 2015 at a tertiary hospital in Taiwan were examined. The MICs of vancomycin were measured using Vitek 2, E-test, and standard broth microdilution at the level of 2 µg/mL. RESULTS: The geometric mean of the MICs of hospital-acquired MRSA was higher than that of community-acquired MRSA (P < 0.001), with the exact agreement rates (with broth microdilution) at 2 µg/mL being 53.6% in Vitek 2 and 86.7% in E-test. Overall, E-test (98.1%) had more categorical accordance than did Vitek 2 (94.0%; P = 0.026). Vitek 2 had a tendency to overestimate MRSA in high-MIC isolates, whereas E-test inclined underestimation in low-MIC isolates. Surprisingly, the discordance rates of MRSA vancomycin MICs were higher in hospital-acquired isolates (13.3%-17.0%) than in community-acquired isolates (6.2%-7.0%). CONCLUSION: The Infectious Diseases Society of America recommends the use of alternative antimicrobial agents when vancomycin MIC is ≥ 2 µg/mL; in this study, only 53.6% of the isolates tested using Vitek 2 showed a high MIC in the broth microdilution method. Accurate identification of the resistance profile is a key component of antimicrobial stewardship programs. Therefore, to reduce inappropriate antibiotic use and mitigate the emergence of resistant strains, we recommend using complementary tests such as E-test or Broth microdilution to verify the MIC before administering second-line antibiotics. STRENGTHS: (1) We compared the categorical agreement between different methods measuring MRSA MICs level. (2) Physicians should incorporate this information and consider a complementary test to verify the appropriateness of the decision of shifting vancomycin to second-line antibiotic treatment to improve patients' prognosis. (3) MRSA-vancomycin MICs at a cutoff of 2 µg/mL obtained using Vitek II exhibited a higher sensitivity level and negative predictive value than those obtained using E-test in the prediction of categorical agreement with standard broth microdilution. LIMITATION: (1) Our research was based on a single hospital-based study. (2) The MRSA strains in this study were stored for more than 12 months after isolation. (3) We did not collect information on clinical prognosis.

Combined surgical and endovascular treatment with arch preservation of acute DeBakey type I aortic dissection.

BACKGROUND: DeBakey type I aortic dissection is a catastrophic event that presents a formidable challenge to cardiovascular surgeon. Here, we evaluate a new combined surgical and endovascular technique for acute condition. METHODS: Between December 2011 and December 2015, 12 patients with type I aortic dissection concomitant involving supra-aortic vessels underwent ascending aortic replacement and simultaneous stent grafts inserted into the descending aorta, left subclavian, and left carotid arteries, and into the innominate artery when possible, without arch replacement. The stent grafts, Gore TAG thoracic endoprosthesis and Viabahn, were deployed under visual guidance through opened aortic arch into the true lumen, with the techniques of circulatory arrest, moderate hypothermia, and bilateral antegrade cerebral perfusion. RESULTS: Operation was performed smoothly in all patients. There was one death, and the other 11 recovered without any neurological deficits. Follow-up computed tomography scans showed that the true lumen expanded and false lumen regressed in both arch and descending aortic segments in 1 year. The diameter did not increase in either arch or descending aortic segments. CONCLUSION: Ascending aortic replacement and stent graft for supra-aortic arteries and the descending aorta without arch replacement are feasible options for type I aortic dissection with satisfactory short-term aortic remodeling.

The effects of functional group counseling on inspiring low-achieving students' self-worth and self-efficacy in Taiwan.

In this study, we investigated the effects of functional group counseling on inspiring low achievers' self-worth and self-efficacy in Taiwan. Forty-three 10th grade low-achieving students volunteered as the Experimental Group to join a 24-week intervention, which integrated and utilized functional group counseling; another 51 10th grade low-achieving students volunteered to be Comparison Group I. In addition, 43 10th grade moderate or high academic achieving students volunteered to be Comparison Group II. All participants completed the Vocational School Student Questionnaire at the beginning and end of this study to measure their self-worth and self-efficacy. In addition, six target students (two boys and four girls) with the lowest total scores on self-worth or self-efficacy in the pretest were selected from the Experimental Group to be interviewed at the end of the intervention and observed weekly. Analyses of variance, analyses of covariance, and paired t-tests assessed the similarity and differences among groups. The initial findings were as follows: Experimental group students had significantly higher scores on self-efficacy and self-worth than both Comparison Group I and Group II students and functional group counseling was shown to significantly affect the low-achieving students. Qualitative results from interviews and observations were used for triangulation and consolidation of quantitative results. Implications of the study included the recommended use of functional group counseling with low-achieving students.

Silencing of p29 affects DNA damage responses with UV irradiation.

Human p29 is a newly identified nuclear protein whose function is largely undetermined. We found that p29 associated with chromatin, interacted with MCM3, and localized with proliferating cell nuclear antigen foci in the S phase. Silencing of p29 using small interfering RNA duplexes reduced DNA synthesis and increased the expression of p107, a member of the RB family, and of cyclin-dependent kinase inhibitor p21, accompanied with a decreased expression of DNA polymerase alpha. Lethal events consisting of premature chromatin condensation with a reduced Chk1 phosphorylation were observed in p29-depleted cells in response to UV irradiation. Intriguingly, the phosphorylation of ataxia telangectasia-mutated kinases at S1981 was suppressed in p29-depleted HeLa cells with UV irradiation, but not in hydroxyurea- and ionizing radiation-treated cells. Taken together, these results reveal a novel function of p29 in the regulation of DNA replication checkpoint responses.

Silencing of astrin induces the p53-dependent apoptosis by suppression of HPV18 E6 expression and sensitizes cells to paclitaxel treatment in HeLa cells.

Astrin is a microtubule-associated protein and localizes with mitotic spindles in the M-phase. We silenced the expression of astrin protein and tested the cell viability in response to paclitaxel treatment in paclitaxel-sensitive and paclitaxel-resistant cells. We found that the absence of astrin by siRNA resulted in the activation of a p53-dependent apoptosis, which elevated pro-apoptotic Bax expression and increased the activity of caspase-3 in astrin-depleted cells. The HPV18 E6 transcription was found to be inhibited along with the increase expression of p53. Intriguingly, the expression of astrin decreased in paclitaxel-sensitive HeLa cells but remained steady in paclitaxel-resistant cells in response to paclitaxel treatment. Furthermore, we identified that the depletion of astrin caused more cell death both in paclitaxel-sensitive and -resistant cells in combination with paclitaxel treatment. These findings suggest that the silencing of astrin induce a p53-dependent apoptosis and has an additive effect on paclitaxel treatment.