Pediatric tympanostomy tube assessment via deep learning.

PURPOSE: Tympanostomy tube (TT) placement is the most frequently performed ambulatory surgery in children under 15. After the procedure it is recommended that patients follow up regularly for "tube checks" until TT extrusion. Such visits incur direct and indirect costs to families in the form of days off from work, copays, and travel expenses. This pilot study aims to compare the efficacy of tympanic membrane (TM) evaluation by an artificial intelligence algorithm with that of clinical staff for determining presence or absence of a tympanostomy tube within the TM. METHODS: Using a digital otoscope, we performed a prospective study in children (ages 10 months-10 years) with a history of TTs who were being seen for follow up in a pediatric otolaryngology clinic. A smartphone otoscope was used by study personnel who were not physicians to take ear exam images, then through conventional otoscopic exam, ears were assessed by a clinician for tubes being in place or tubes having extruded from the TM. We trained and tested a deep learning (artificial intelligence) algorithm to assess the images and compared that with the clinician's assessment. RESULTS: A total of 123 images were obtained from 28 subjects. The algorithm classified images as TM with or without tube in place. Overall classification accuracy was 97.7 %. Recall and precision were 100 % and 96 %, respectively, for TM without a tube present, and 95 % and 100 %, respectively, for TM with a tube in place. DISCUSSION: This is a promising deep learning algorithm for classifying ear tube presence in the TM utilizing images obtained in awake children using an over-the-counter otoscope available to the lay population. We are continuing enrollment, with the goal of building an algorithm to assess tube patency and extrusion.

Development of THOR-FLx: A Biofidelic Lower Extremity for Use with 5th Percentile Female Crash Test Dummies.

A new lower leg/ankle/foot system has been designed and fabricated to assess the potential for lower limb injuries to small females in the automotive crash environment. The new lower extremity can be retrofitted at present to the distal femur of the 5th percentile female Hybrid III dummy. Future plans are for integration of this design into the 5th percentile female THOR dummy now under development. The anthropometry of the lower leg and foot is based mainly on data developed by Robbins for the 5th percentile female, while the biomechanical response requirements are based upon scaling of 50th percentile male THOR-Lx responses. The design consists of the knee, tibia, ankle joints, foot, a representation of the Achilles tendon, and associated flesh/skins. The new lower extremity, known as THOR-FLx, is designed to be biofidelic under dynamic axial loading of the tibia, static and dynamic dorsiflexion, static plantarflexion and inversion/eversion. Instrumentation includes accelerometers, load cells, and rotary potentiometers to capture relevant kinematic and dynamic information from the foot and tibia. This paper will describe the performance requirements for THOR-FLx, the methodology used in its' development, results of component tests, and the biofidelity tests conducted on the full assembly.

Depleted red cell membrane essential fatty acids in drug-treated schizophrenic patients.

The fatty acid composition of red blood cell membranes from 23 drug-treated schizophrenic patients was measured and compared with a healthy control group. There were substantial depletions of fatty acids from the n6 and n3 series, particularly arachidonic and docosahexanoic acid. Significant negative correlations between depleted n6 fatty acids and plasma levels of thiobarbituric acid reactive substances suggests that depletion is caused by increased breakdown of these fatty acids rather than by impaired incorporation of fatty acids into membranes. Arachidonic and docosahexanoic acids appear to show a bimodal distribution. We propose that this may be a metabolic abnormality which is of aetiological importance in schizophrenia.

Tardive dyskinesia, lipid peroxidation, and sustained amelioration with vitamin E treatment.

Plasma levels of thiobarbituric acid reactive substances (TBARS) were measured as an indicator of lipid peroxidation, in 14 patients suffering from tardive dyskinesia (TD). There was a highly significant positive correlation between plasma TBARS (both basal and iron stimulated) and severity of TD. Patients were then treated for 1 month with the free radical scavenger vitamin E (1200 i.u. daily). Following vitamin E treatment, there was a clinically and statistically significant amelioration of TD, and this improvement was maintained at follow-up 7-13 months later. There was no consistent or significant change in plasma TBARS levels related to treatment with vitamin E.