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Objective: To overcome limitations of open surgery artificial intelligence (AI) models by curating the largest collection of annotated videos and to leverage this AI-ready data set to develop a generalizable multitask AI model capable of real-time understanding of clinically significant surgical behaviors in prospectively collected real-world surgical videos. Design, Setting, and Participants: The study team programmatically queried open surgery procedures on YouTube and manually annotated selected videos to create the AI-ready data set used to train a multitask AI model for 2 proof-of-concept studies, one generating surgical signatures that define the patterns of a given procedure and the other identifying kinematics of hand motion that correlate with surgeon skill level and experience. The Annotated Videos of Open Surgery (AVOS) data set includes 1997 videos from 23 open-surgical procedure types uploaded to YouTube from 50 countries over the last 15 years. Prospectively recorded surgical videos were collected from a single tertiary care academic medical center. Deidentified videos were recorded of surgeons performing open surgical procedures and analyzed for correlation with surgical training. Exposures: The multitask AI model was trained on the AI-ready video data set and then retrospectively applied to the prospectively collected video data set. Main Outcomes and Measures: Analysis of open surgical videos in near real-time, performance on AI-ready and prospectively collected videos, and quantification of surgeon skill. Results: Using the AI-ready data set, the study team developed a multitask AI model capable of real-time understanding of surgical behaviors-the building blocks of procedural flow and surgeon skill-across space and time. Through principal component analysis, a single compound skill feature was identified, composed of a linear combination of kinematic hand attributes. This feature was a significant discriminator between experienced surgeons and surgical trainees across 101 prospectively collected surgical videos of 14 operators. For each unit increase in the compound feature value, the odds of the operator being an experienced surgeon were 3.6 times higher (95% CI, 1.67-7.62; P = .001). Conclusions and Relevance: In this observational study, the AVOS-trained model was applied to analyze prospectively collected open surgical videos and identify kinematic descriptors of surgical skill related to efficiency of hand motion. The ability to provide AI-deduced insights into surgical structure and skill is valuable in optimizing surgical skill acquisition and ultimately improving surgical care.
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Inteligência Artificial , Aprendizado de Máquina , Humanos , Estudos Retrospectivos , Gravação em Vídeo/métodos , Centros Médicos AcadêmicosRESUMO
This study aimed to simulate conditions in which dispersant (Dasic NS) might be used to combat an oil spill in coastal sub-Arctic water of limited depth and water exchange in order to produce input data for Net Environmental Benefit Analysis (NEBA) of Arctic and sub-Arctic coastal areas. Concentration dependent differences in acute responses and long-term effects of a 48h acute exposure to dispersed oil, with and without the application of a chemical dispersant, were assessed on the Arctic filter feeding bivalve Chlamys islandica. Icelandic scallops were exposed for 48h to a range of spiked concentrations of mechanically and chemically dispersed oil. Short-term effects were assessed in terms of lysosomal membrane stability, superoxide dismutase, catalase, gluthatione S-transferases, glutathione peroxidases, glutathione reductase, glutathione, total oxyradical scavenging capacity, lipid peroxidation and peroxisomal proliferation. Post-exposure survival, growth and reproductive investment were followed for 2 months to evaluate any long-term consequence. Generally, similar effects were observed in scallops exposed to mechanically and chemically dispersed oil. Limited short-term effects were observed after 48h, suggesting that a different timing would be required for measuring the possible onset of such effects. There was a concentration dependent increase in cumulative post-exposure mortality, but long-term effects on gonadosomatic index, somatic growth/condition factor did not differ among treatments.
Assuntos
Pectinidae/efeitos dos fármacos , Poluição por Petróleo/efeitos adversos , Petróleo/toxicidade , Poluentes Químicos da Água/toxicidade , Análise de Variância , Animais , Antioxidantes/metabolismo , Regiões Árticas , Membrana Celular/efeitos dos fármacos , Glutationa/metabolismo , Peroxidação de Lipídeos/efeitos dos fármacos , Lisossomos/efeitos dos fármacos , Modelos Biológicos , Estresse Oxidativo/efeitos dos fármacos , Pectinidae/enzimologia , Pectinidae/crescimento & desenvolvimento , Tensoativos/farmacologiaRESUMO
Introduced over 200 yr ago to the east coast of North America, Carcinus maenas now ranges from New York to Newfoundland. In the 1980s, a secondary invasion of European lineages, termed northern haplotypes, occurred in Nova Scotia. Young-of-the-year sampled in 2007 revealed that northern haplotypes were present in low frequencies at several northwestern Atlantic sites as far south as New York; a model predicted an increase in their range and frequency over time. We collected samples in 2013 and 2014 to determine the haplotypes of adult crabs from New York to Nova Scotia. Six haplotypes, encompassing previously identified northern and southern haplotypes, 1 novel southern haplotype, and 1 Scandinavian haplotype, were identified in 275 crabs sampled at 11 sites. Northern haplotypes were only found in Nova Scotia, Beals Island (Maine), and Mount Desert Island (Maine) at a frequency of 60, 8, and 24%, respectively; remaining sites were predominantly composed of a previously identified southern haplotype. Northern haplotypes are limited in adult crabs to Mount Desert Island and north, indicating that the southern haplotype is selectively favored at some point during their life history, recruitment of northern larvae is limited south of Mount Desert Island, or entire year-classes post-2007 were lost. Our results do not support the predictions of an increase in the range and frequency of northern haplotypes, at least among adults, and indicate that a more complete knowledge of factors affecting C. maenas life stages is necessary to understand the current distribution of haplotypes.
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BACKGROUND: Emergency department (ED) human immunodeficiency virus (HIV) screening programs are challenged by the unsustainable cost of exogenous staff and the relatively low penetration rates. Kiosk systems have increased registration efficiency in various clinical settings and have shown promising results for advancing various public health initiatives. This study evaluated the usability of kiosks within the existing HIV testing program and assessed patients' perceived acceptability of kiosk-based screening in the ED. SUBJECTS AND METHODS: ED patients (n=88) were asked to complete both a Registration Module (intended to integrate into the ED's pending kiosk registration system) and a Risk Assessment Module using a pen-based touchscreen tablet platform. Participants provided feedback upon program completion. All comments, questions, and errors were documented. Kiosk programs tracked time spent on each screen. Quantitative (chi-squared test or t test) and qualitative data analyses were performed. RESULTS: Consented subjects (n=62) were 60% female, 69% were black, the mean ± standard deviation age was 37.8 ± 11.4 years, 52% had a high school degree or less, and 50% reported no prior kiosk experience. Mean time spent on the Registration and Risk Assessment Modules was 2:35 ± 1:24 min and 5:09 ± 1:58 min, respectively. The leading technical challenge identified was login: 84% of patients required assistance. Removal of the login screen reduced times to 1:05 ± 0:36 min and 4:10 ± 1:38 min. Ninety-five percent of subjects reported length of use as "just right," and over 75% of patients found the software easy to use, answered questions without help, and preferred screening on the kiosk to in-person interviews. Favorite aspects of the program included ease of use (52%), privacy (48%), and speed (30%). Sixty-six percent of patients reported there was nothing they disliked or would change. CONCLUSIONS: ED patient response to the kiosk system was favorable. Subjects easily and quickly navigated the program, with the exception of a login screen, which could be eliminated via automated login using ID bracelet scanners.
Assuntos
Serviço Hospitalar de Emergência , Infecções por HIV/diagnóstico , Programas de Rastreamento/métodos , Interface Usuário-Computador , Centros Médicos Acadêmicos , Adulto , Baltimore , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Medição de Risco , Fatores de Tempo , População Urbana , Adulto JovemRESUMO
Organochlorine compounds (OC) were determined in Arctic bivalves (Mya truncata, Serripes groenlandicus, Hiatella arctica and Chlamys islandica) from Svalbard with regard to differences in geographic location, species and variations related to their size and age. Higher chlorinated polychlorinated biphenyls (PCB 101-PCB 194), chlordanes and α-hexachlorocyclohexane (α-HCH) were consistently detected in the bivalves and PCBs dominated the OC load in the organisms. OC concentrations were highest in Mya truncata and the lowest in Serripes groenlandicus. Species-specific OC levels were likely related to differences in the species' food source, as indicated by the δ(13)C results, rather than size and age. Higher OC concentrations were observed in bivalves from Kongsfjorden compared to the northern sampling locations Liefdefjorden and Sjuøyane. The spatial differences might be related to different water masses influencing Kongsfjorden (Atlantic) and the northern locations (Arctic), with differing phytoplankton bloom situations.