Artificial Intelligent Agent Architecture and Clinical Decision-Making in the Healthcare Sector.

This paper examines the decision-making processes of physicians and intelligent agents within the healthcare sector, particularly focusing on their characteristics, architectures, and approaches. We provide a theoretical insight into the evolving role of artificial intelligence (AI) in healthcare, emphasizing its potential to address various healthcare challenges. Defining features of intelligent agents are explored, including their perceptual abilities and behavioral properties, alongside their architectural frameworks, ranging from reflex-based to general learning agents, and contrasted with the rational decision-making structure employed by physicians. Through data collection, hypothesis generation, testing, and reflection, physicians exhibit a nuanced approach informed by adaptability and contextual understanding. A comparative analysis between intelligent agents and physicians reveals both similarities and disparities, particularly in adaptability and contextual comprehension. While intelligent agents offer promise in enhancing clinical decisions, challenges with types of dataset biases pose significant hurdles. Informing and educating physicians about AI concepts can build trust and transparency in intelligent programs. Such efforts aim to leverage the strengths of both human and AI toward improving healthcare delivery and outcomes.

A prospective randomized study of arthroscopic ACL reconstruction with adjustable- versus fixed-loop device for femoral side fixation.

PURPOSE: Suspensory devices are extensively used in the management of anterior cruciate ligament (ACL) tear. They include fixed- and adjustable-loop devices. There are only a few studies comparing the efficacy of these two devices in the available literature. Therefore, the aim of this study is to compare clinical outcomes between the adjustable-loop device (group I) and fixed-loop device (group II). MATERIALS AND METHODS: This was a prospective randomized study. Both groups were equivalent in demographic, preoperative, and intraoperative variables. Twenty-three patients underwent femoral side graft fixation with adjustable-loop and 20 with fixed-loop devices. Four patients were lost to follow-up. Assessment of clinical outcome was done with International Knee Documentation Committee (IKDC) score, Lysholm score, and knee stability tests (Lachman test and pivot shift test). Patient evaluation was performed preoperatively and finally postoperatively 2 years after surgery. RESULTS: Postoperative IKDC scores of group I and II were 91.9 ± 3.6 and 91.5 ± 3.6, respectively, and Lysholm scores were 91.0 ± 3.6 and 91.4 ± 3.5, respectively, after 2 years; however, the difference in the outcomes was statistically insignificant (p > 0.05). Twenty patients (87%) in group I and 17 patients (85%) in group II had a negative Lachman test (p = 0.8). Twenty-two patients (95.7%) in group I and 19 patients (95%) in group II had a negative pivot shift test (p = 0.9). CONCLUSION: ACL reconstruction with fixed- and adjustable-loop suspensory devices for graft fixation gives equivalent and satisfactory clinical results. LEVEL OF EVIDENCE: 1.

Identification and analysis of stable breathing periods in electrical impedance tomography recordings.

Objective. In this paper, an automated stable tidal breathing period (STBP) identification method based on processing electrical impedance tomography (EIT) waveforms is proposed and the possibility of detecting and identifying such periods using EIT waveforms is analyzed. In wearable chest EIT, patients breathe spontaneously, and therefore, their breathing pattern might not be stable. Since most of the EIT feature extraction methods are applied to STBPs, this renders their automatic identification of central importance.Approach. The EIT frame sequence is reconstructed from the raw EIT recordings and the raw global impedance waveform (GIW) is computed. Next, the respiratory component of the raw GIW is extracted and processed for the automatic respiratory cycle (breath) extraction and their subsequent grouping into STBPs.Main results. We suggest three criteria for the identification of STBPs, namely, the coefficient of variation of (i) breath tidal volume, (ii) breath duration and (iii) end-expiratory impedance. The total number of true STBPs identified by the proposed method was 294 out of 318 identified by the expert corresponding to accuracy over 90%. Specific activities such as speaking, eating and arm elevation are identified as sources of false positives and their discrimination is discussed.Significance. Simple and computationally efficient STBP detection and identification is a highly desirable component in the EIT processing pipeline. Our study implies that it is feasible, however, the determination of its limits is necessary in order to consider the implementation of more advanced and computationally demanding approaches such as deep learning and fusion with data from other wearable sensors such as accelerometers and microphones.

Sounding out life in the deep using acoustic data from ships of opportunity.

Shedding light on the distribution and ecosystem function of mesopelagic communities in the twilight zone (~200-1000 m depth) of global oceans can bridge the gap in estimates of species biomass, trophic linkages, and carbon sequestration role. Ocean basin-scale bioacoustic data from ships of opportunity programs are increasingly improving this situation by providing spatio-temporal calibrated acoustic snapshots of mesopelagic communities that can mutually complement established global ecosystem, carbon, and biogeochemical models. This data descriptor provides an overview of such bioacoustic data from Australia's Integrated Marine Observing System (IMOS) Ships of Opportunity (SOOP) Bioacoustics sub-Facility. Until 30 September 2020, more than 600,000 km of data from 22 platforms were processed and made available to a publicly accessible Australian Ocean Data Network (AODN) Portal. Approximately 67% of total data holdings were collected by 13 commercial fishing vessels, fostering collaborations between researchers and ocean industry. IMOS Bioacoustics sub-Facility offers the prospect of acquiring new data, improved insights, and delving into new research challenges for investigating status and trend of mesopelagic ecosystems.

Comparative Evaluation of Two Different Flap Designs and Postoperative Outcome in the Surgical Removal of Impacted Mandibular Third Molar.

AIM: The aim of this study is to compare triangular and envelope flap designs and the postoperative outcome in the surgical removal of impacted mandibular third molar. MATERIALS AND METHODS: A total of 50 participants were assessed clinically and were divided randomly into two groups. Group I (participants operated by triangular flap) and group II (participants operated by envelope flap), with 25 participants each between the age group of 20 and 30 years. Patient satisfaction was assessed subjectively using a graded scale from very satisfied to very unsatisfied. The degree of pain was recorded for 7 days with reference to predefined values on visual analog scale (VAS). Trismus was evaluated on the day 3, day 5, and day 7 of the postoperative period in millimeters. Quantitative data were analyzed by unpaired t-test and qualitative data were by Fischer's exact test. RESULTS: The mean overall age is 25.5 years. There was no statistically significant difference between the study groups with respect to age. There was no significant association between the patient satisfaction and flap type (p = 0.684). A significant difference between the study groups on 4th, 5th, and 6th days with respect to pain was observed, wherein fewer subjects operated with triangular flap reported pain. A highly significant difference in mouth opening was observed, with triangular flap group participants having a higher mouth opening than envelope flap subjects on day 7. CONCLUSION: The present study indicated that participants operated by triangular flap had a better mouth opening postoperatively compared with envelope flap participants, whereas there were no significant differences in patient satisfaction and pain scores at the end of the 7th day after third molar surgery. CLINICAL SIGNIFICANCE: Flap design is a significant factor in the surgical removal of impacted third molar, and it influences the severity of complications. Furthermore, it is important for allowing optimal visibility and access to the impacted tooth and also for subsequent healing of the surgically created defect.

Autofluorescence based diagnostic techniques for oral cancer.

Oral cancer is one of the most common cancers worldwide. Despite of various advancements in the treatment modalities, oral cancer mortalities are more, particularly in developing countries like India. This is mainly due to the delay in diagnosis of oral cancer. Delay in diagnosis greatly reduces prognosis of the treatment and also cause increased morbidity and mortality rates. Early diagnosis plays a key role in effective management of oral cancer. A rapid diagnostic technique can greatly aid in the early diagnosis of oral cancer. Now a day's many adjunctive oral cancer screening techniques are available for the early diagnosis of cancer. Among these, autofluorescence based diagnostic techniques are rapidly emerging as a powerful tool. These techniques are broadly discussed in this review.

The role of myofibroblasts in wound healing, contraction and its clinical implications in cleft palate repair.

Myofibroblasts after its discovery in 1971 as the principal cell for wound healing has come a long way as far as research is concerned. The primary focus of research has been regarding preventing certain unwanted effects of this cell such as wound contraction and scarring. As far as the oral and maxillofacial region is concerned, the primary concern of this untoward effect is during repair of cleft palate surgically which results impaired development of palate and the dentoalveolar structures. This review focuses on the basic aspects of myofibroblasts such as its origin, formation, function in wound healing, role in wound contraction and ways by which its unwanted effects can be overcome to improve the quality of the post surgical complications of cleft palate surgery.

Multifractal detrended fluctuation analysis to characterize phase couplings in seahorse (Hippocampus kuda) feeding clicks.

Nonlinear phenomena in animal vocalizations fundamentally includes known features, namely, frequency jump, subharmonics, biphonation, and deterministic chaos. In the present study, the multifractal detrended fluctuation analysis (MFDFA) has been employed to characterize the phase couplings revealed in the feeding clicks of Hippocampus kuda yellow seahorse. The fluctuation function Fq(s), generalized Hurst exponent h(q), multifractal scaling exponent τ(q), and the multifractal spectrum f(α) calculated in the procedure followed were analyzed to comprehend the underlying nonlinearities in the seahorse clicks. The analyses carried out reveal long-range power-law correlation properties in the data, substantiating the multifractal behavior. The resulting h(q) spectrum exhibits a distinct characteristic pattern in relation to the seahorse sex and size, and reveals a spectral blind spot in the data that was not possible to detect by conventional spectral analyses. The corresponding multifractal spectrum related width parameter Δh(q) is well clustered, defining the individual seahorse clicks. The highest degree of multifractality is evident in the 18 cm male seahorse, signifying greater heterogeneity. A further comparison between the seahorse body size and weight (wet) with respect to the width parameter Δh(q) and the second-order Hurst exponent h(q=2) underscores the versatility of MFDFA as a robust statistical tool to analyze bioacoustic observations.

Fast ion surface energy loss and straggling in the surface wake fields.

We have measured the stopping powers and straggling of fast, highly ionized atoms passing through thin bilayer targets made up of metals and insulators. We were surprised to find that the energy losses as well as the straggling depend on the ordering of the target and have small but significantly different values on bilayer reversal. We ascribe this newly found difference in energy loss to the surface energy loss field effect due to the differing surface wake fields as the beam exits the target in the two cases. This finding is validated with experiments using several different projectiles, velocities, and bilayer targets. Both partners of the diatomic molecular ions also display similar results. A comparison of the energy loss results with those of previous theoretical predictions for the surface wake potential for fast ions in solids supports the existence of a self-wake.

Model-based seafloor characterization employing multi-beam angular backscatter data--a comparative study with dual-frequency single beam.

Sediment geoacoustic inversion results are estimated employing a multi-beam (MB) echo-sounding system operable at 95 kHz. To characterize the western continental shelf of India (off Goa) seafloor, MB backscatter signals were acquired along with grab sediment samples. The substrate type and roughness of the site were estimated using the composite roughness scattering model with the measured backscatter values. The seafloor parameters, namely mean grain size (M(φ)); roughness spectrum strength (w(2)) and exponent (γ(2)); and sediment volume parameter (σ(2)), for coarse and fine grain sediments are estimated by employing the MB system. These parameters have also been estimated at two other frequencies (33 and 210 kHz) and are compared to the ground truth data to provide sufficient support in validating the model results and increasing the understanding of the shelf seafloor processes. Distinct interclass separations between the sediment provinces are evident from the estimated mean grain size M(φ) and water-sediment interface roughness w(2). The seafloor parameters for coarse and fine grain sediments derived from the 95 kHz MB data are consistent with the sediment sample data as well as with the inversion results obtained using backscatter data at 33 and 210 kHz from the same locations.

Information technology can enhance quality in regional health delivery.

OBJECTIVES: a) The use of information technology (IT) based solutions for quality health delivery in regional health information networks and the study of the enabling factors for their use in a regional health care network from key classes of users such as the medical personnel and the citizens. b) Identification of potential technologies for usage from all citizens and health providers in a regional environment, in all aspects of everyday life. c) Presentation of a generic user model for reference when developing and assessing IT based health delivery solutions. METHODS: After defining the major questions to be addressed, an overview of tele-health and tele-medicine technologies and solutions currently available shall be presented. Further, a generic user model applied to the use of IT based regional health delivery solutions both for the daily life and home care, and for research and clinical routine purposes are presented. Enabling technologies for integration of different IT modules, medical data processing and management procedures and the wireless application protocol (WAP) technology is discussed. RESULTS: Different levels of user applications are presented such as mobile telephony driven health information monitoring and systems integrating electronic health care records with multimedia medical information management and processing modules. CONCLUSIONS: Although IT solutions are advanced and continue to evolve, still the user acceptance and user friendliness issues are unresolved. Mobile telecommunication solutions however may hold the key for wide scale implementation of IT solutions in regional health information networks and increased quality of health services.

Model-based morphological segmentation and labeling of coronary angiograms.

A method for extraction and labeling of the coronary arterial tree (CAT) using minimal user supervision in single-view angiograms is proposed. The CAT structural description (skeleton and borders) is produced, along with quantitative information for the artery dimensions and assignment of coded labels, based on a given coronary artery model represented by a graph. The stages of the method are: 1) CAT tracking and detection; 2) artery skeleton and border estimation; 3) feature graph creation; and iv) artery labeling by graph matching. The approximate CAT centerline and borders are extracted by recursive tracking based on circular template analysis. The accurate skeleton and borders of each CAT segment are computed, based on morphological homotopy modification and watershed transform. The approximate centerline and borders are used for constructing the artery segment enclosing area (ASEA), where the defined skeleton and border curves are considered as markers. Using the marked ASEA, an artery gradient image is constructed where all the ASEA pixels (except the skeleton ones) are assigned the gradient magnitude of the original image. The artery gradient image markers are imposed as its unique regional minima by the homotopy modification method, the watershed transform is used for extracting the artery segment borders, and the feature graph is updated. Finally, given the created feature graph and the known model graph, a graph matching algorithm assigns the appropriate labels to the extracted CAT using weighted maximal cliques on the association graph corresponding to the two given graphs. Experimental results using clinical digitized coronary angiograms are presented.

Hybrid image segmentation using watersheds and fast region merging.

A hybrid multidimensional image segmentation algorithm is proposed, which combines edge and region-based techniques through the morphological algorithm of watersheds. An edge-preserving statistical noise reduction approach is used as a preprocessing stage in order to compute an accurate estimate of the image gradient. Then, an initial partitioning of the image into primitive regions is produced by applying the watershed transform on the image gradient magnitude. This initial segmentation is the input to a computationally efficient hierarchical (bottom-up) region merging process that produces the final segmentation. The latter process uses the region adjacency graph (RAG) representation of the image regions. At each step, the most similar pair of regions is determined (minimum cost RAG edge), the regions are merged and the RAG is updated. Traditionally, the above is implemented by storing all RAG edges in a priority queue. We propose a significantly faster algorithm, which additionally maintains the so-called nearest neighbor graph, due to which the priority queue size and processing time are drastically reduced. The final segmentation provides, due to the RAG, one-pixel wide, closed, and accurately localized contours/surfaces. Experimental results obtained with two-dimensional/three-dimensional (2-D/3-D) magnetic resonance images are presented.

Coronary artery skeleton detection based on topographic features.

A new approach to the problem of detecting the skeletons of coronary arteries in coronary angiograms is proposed. The digitized grayscale coronary angiograms are regarded as noisy sampling of the underlying continuous surface. After the application of Gaussian filtering to reduce noise, the topographic features of the smoothed image are detected based on first and second order image derivatives. Then, the candidate arteries skeleton points are detected based on the observation that arteries are smooth elongated objects having approximately a Gaussian smoothed semi-elliptical profile. Experimental results on real digitized coronary angiograms are presented.