Human vs. Machine Learning Based Detection of Facial Weakness Using Video Analysis.

Background: Current EMS stroke screening tools facilitate early detection and triage, but the tools' accuracy and reliability are limited and highly variable. An automated stroke screening tool could improve stroke outcomes by facilitating more accurate prehospital diagnosis and delivery. We hypothesize that a machine learning algorithm using video analysis can detect common signs of stroke. As a proof-of-concept study, we trained a computer algorithm to detect presence and laterality of facial weakness in publically available videos with comparable accuracy, sensitivity, and specificity to paramedics. Methods and Results: We curated videos of people with unilateral facial weakness (n = 93) and with a normal smile (n = 96) from publicly available web-based sources. Three board certified vascular neurologists categorized the videos according to the presence or absence of weakness and laterality. Three paramedics independently analyzed each video with a mean accuracy, sensitivity and specificity of 92.6% [95% CI 90.1-94.7%], 87.8% [95% CI 83.9-91.7%] and 99.3% [95% CI 98.2-100%]. Using a 5-fold cross validation scheme, we trained a computer vision algorithm to analyze the same videos producing an accuracy, sensitivity and specificity of 88.9% [95% CI 83.5-93%], 90.3% [95% CI 82.4-95.5%] and 87.5 [95% CI 79.2-93.4%]. Conclusions: These preliminary results suggest that a machine learning algorithm using computer vision analysis can detect unilateral facial weakness in pre-recorded videos with an accuracy and sensitivity comparable to trained paramedics. Further research is warranted to pursue the concept of augmented facial weakness detection and external validation of this algorithm in independent data sets and prospective patient encounters.

Operation BRAVE families: A preventive approach to lessening the impact of war on military families through preclinical engagement.

OBJECTIVES: Operation Building Resilience and Valuing Empowered Families (OBF) is a preventive, preclinical program that was developed by the Walter Reed National Military Medical Center's Child and Adolescent Psychiatry Service to form a working partnership with families of wounded warrior parents from the war in Iraq and Afghanistan. The OBF staff helps to identify the families' needs and collaborates with many organizations at Walter Reed National Military Medical Center to provide assistance. This article describes OBF, offers a case description, reviews current preventive programs for children exposed to trauma and disaster, and compares and contrasts OBF to these programs. METHODS: A literature review was performed, searching Ovid MEDLINE for keywords, such as posttraumatic stress disorder, child and adolescent, family, prevention, and disaster. RESULTS: There are an increasing number of preventive programs for children and adolescents throughout the country, especially over the past 10 years. These programs build upon past prevention models. There are few services that offer primary prevention. CONCLUSIONS: OBF is a military treatment facility-focused preventive program that can serve as a program model for other military treatment facilities and civilian hospitals with the mandate to care for the family members and children of parents who are trauma victims and require long-term care.

Psychiatric medications for deployment: an update.

OBJECTIVE: This article discusses issues regarding the usage of psychotropic medications during military deployments, with emphasis on Operation Iraqi Freedom. METHOD: The role of psychotropic medications in the Army combat stress control doctrine is reviewed and compared with operational experiences of psychiatrists who have deployed to Iraq, Bosnia, and Egypt. RESULTS: Many issues regarding psychotropic medications experienced by deployed psychiatrists are not discussed in the Army combat stress control doctrine. CONCLUSION: The advent of new psychotropic medications, the changes in the types of conflicts fought, and the role of National Guard and Reserve forces in current conflicts have all had an impact on the role and usage of psychotropic medications during military deployments.