Machine learning in clinical practice: Evaluation of an artificial intelligence tool after implementation.

OBJECTIVE: Artificial intelligence (AI) has gradually found its way into healthcare, and its future integration into clinical practice is inevitable. In the present study, we evaluate the accuracy of a novel AI algorithm designed to predict admission based on a triage note after clinical implementation. This is the first of such studies to investigate real-time AI performance in the emergency setting. METHODS: The novel AI algorithm that predicts admission using a triage note was translated into clinical practice and integrated within St Vincent's Hospital Melbourne's electronic emergency patient management system. The data were collected from 1 January 2021 to 17 August 2022 to evaluate the diagnostic accuracy of the AI system after implementation. RESULTS: A total of 77 125 ED presentations were included. The live AI algorithm has a sensitivity of 73.1% (95% confidence interval 72.5-73.8), specificity of 74.3% (73.9-74.7), positive predictive value of 50% (49.6-50.4) and negative predictive value of 88.7% (88.5-89) with a total accuracy of 74% (73.7-74.3). The accuracy of the system was at the lowest for admission to psychiatric units (34%) and at the highest for gastroenterology and medical admission (84% and 80%, respectively). CONCLUSION: Our study showed the diagnostic evaluation of a real-time AI clinical decision-support tool became less accurate than the original. Although real-time sensitivity and specificity of the AI tool was still acceptable as a decision-support tool in the ED, we propose that continuous training and evaluation of AI-enabled clinical support tools in healthcare are conducted to ensure consistent accuracy and performance to prevent inadvertent consequences.

Evaluation of techniques to improve a deep learning algorithm for the automatic detection of intracranial haemorrhage on CT head imaging.

BACKGROUND: Deep learning (DL) algorithms are playing an increasing role in automatic medical image analysis. PURPOSE: To evaluate the performance of a DL model for the automatic detection of intracranial haemorrhage and its subtypes on non-contrast CT (NCCT) head studies and to compare the effects of various preprocessing and model design implementations. METHODS: The DL algorithm was trained and externally validated on open-source, multi-centre retrospective data containing radiologist-annotated NCCT head studies. The training dataset was sourced from four research institutions across Canada, the USA and Brazil. The test dataset was sourced from a research centre in India. A convolutional neural network (CNN) was used, with its performance compared against similar models with additional implementations: (1) a recurrent neural network (RNN) attached to the CNN, (2) preprocessed CT image-windowed inputs and (3) preprocessed CT image-concatenated inputs. The area under the receiver operating characteristic curve (AUC-ROC) and microaveraged precision (mAP) score were used to evaluate and compare model performances. RESULTS: The training and test datasets contained 21,744 and 491 NCCT head studies, respectively, with 8,882 (40.8%) and 205 (41.8%) positive for intracranial haemorrhage. Implementation of preprocessing techniques and the CNN-RNN framework increased mAP from 0.77 to 0.93 and increased AUC-ROC [95% confidence intervals] from 0.854 [0.816-0.889] to 0.966 [0.951-0.980] (p-value = 3.91 × 10-12). CONCLUSIONS: The deep learning model accurately detected intracranial haemorrhage and improved in performance following specific implementation techniques, demonstrating clinical potential as a decision support tool and an automated system to improve radiologist workflow efficiency. KEY POINTS: • The deep learning model detected intracranial haemorrhages on computed tomography with high accuracy. • Image preprocessing, such as windowing, plays a large role in improving deep learning model performance. • Implementations which enable an analysis of interslice dependencies can improve deep learning model performance. • Visual saliency maps can facilitate explainable artificial intelligence systems. • Deep learning within a triage system may expedite earlier intracranial haemorrhage detection.

Postural displacement induced by electrical stimulation; A new approach to examine postural recovery.

BACKGROUND: Controlling upright posture entails acute adjustments by the neuromuscular system to keep the center of mass (COM) within the limits of a relatively small base of support. Sudden displacement of the COM triggers several strategies and balance recovery mechanisms to prevent excessive COM displacement. NEW METHOD: We have examined and quantified a new approach to induce an internal neuromuscular perturbation in standing posture on 15 healthy individuals to provide an insight into the mechanism of loss of balance (LOB). The method comprises eliciting an H-reflex protocol while subjects are standing which produces a contraction in soleus and gastrocnemius muscles. We have also defined analytical techniques to provide biomarkers of balance control during perturbation. We used M-Max unilaterally or bilaterally and induced a forward or sideway perturbation. The vector analysis and the Equilibrium Point calculations defined here can quantify the amplitude, direction, and evolution of the perturbation. RESULTS: Clear patterns of loss of balance due to stimulation was observed. Compared to quiet standing, the density of the EPs substantially increased in the perturbation phase. Leftward stimulation produced significantly higher number of EPs compared to the bilateral stimulation condition which could be due to the fact that the left leg was the nondominant side in all our subjects. COMPARISON AND CONCLUSION: In this study we provide a proof-of-concept technique for examining recovery from perturbation. The advantage of this technique is that it provides a safe perturbation, is internally induced at the spinal cord level, and is free from other factors that might complicate the recovery analysis (e.g., locomotion and the integration of the spinal pattern generator and cutaneous pathways in mediating changes). We have shown that the perturbation induced by this method can be quantified as vectors. We have also shown that the density of instantaneous equilibrium points (EPs) could be a good biomarker for defining and examining the perturbation phase. Thus, this protocol and analysis provides a unique individual assessment of recovery which can be used to assess interventions. Finally, given that the maximal motor response is used as the perturbation (e.g., M-max) it is highly reliable and reproducible within an individual patient.

Development of a machine learning-based real-time location system to streamline acute endovascular intervention in acute stroke: a proof-of-concept study.

BACKGROUND: Delivery of acute stroke endovascular intervention can be challenging because it requires complex coordination of patient and staff across many different locations. In this proof-of-concept paper we (a) examine whether WiFi fingerprinting is a feasible machine learning (ML)-based real-time location system (RTLS) technology that can provide accurate real-time location information within a hospital setting, and (b) hypothesize its potential application in streamlining acute stroke endovascular intervention. METHODS: We conducted our study in a comprehensive stroke care unit in Melbourne, Australia that offers a 24-hour mechanical thrombectomy service. ML algorithms including K-nearest neighbors, decision tree, random forest, support vector machine and ensemble models were trained and tested on a public WiFi dataset and the study hospital WiFi dataset. The hospital dataset was collected using the WiFi explorer software (version 3.0.2) on a MacBook Pro (AirPort Extreme, Broadcom BCM43x×1.0). Data analysis was implemented in the Python programming environment using the scikit-learn package. The primary statistical measure for algorithm performance was the accuracy of location prediction. RESULTS: ML-based WiFi fingerprinting can accurately predict the different hospital zones relevant in the acute endovascular intervention workflow such as emergency department, CT room and angiography suite. The most accurate algorithms were random forest and support vector machine, both of which were 98% accurate. The algorithms remain robust when new data points, which were distinct from the training dataset, were tested. CONCLUSIONS: ML-based RTLS technology using WiFi fingerprinting has the potential to streamline delivery of acute stroke endovascular intervention by efficiently tracking patient and staff movement during stroke calls.

Artificial intelligence in clinical decision support and outcome prediction - applications in stroke.

Artificial intelligence (AI) is making a profound impact in healthcare, with the number of AI applications in medicine increasing substantially over the past five years. In acute stroke, it is playing an increasingly important role in clinical decision-making. Contemporary advances have increased the amount of information - both clinical and radiological - which clinicians must consider when managing patients. In the time-critical setting of acute stroke, AI offers the tools to rapidly evaluate and consolidate available information, extracting specific predictions from rich, noisy data. It has been applied to the automatic detection of stroke lesions on imaging and can guide treatment decisions through the prediction of tissue outcomes and long-term functional outcomes. This review examines the current state of AI applications in stroke, exploring their potential to reform stroke care through clinical decision support, as well as the challenges and limitations which must be addressed to facilitate their acceptance and adoption for clinical use.

Review of deep learning algorithms for the automatic detection of intracranial hemorrhages on computed tomography head imaging.

Artificial intelligence is a rapidly evolving field, with modern technological advances and the growth of electronic health data opening new possibilities in diagnostic radiology. In recent years, the performance of deep learning (DL) algorithms on various medical image tasks have continually improved. DL algorithms have been proposed as a tool to detect various forms of intracranial hemorrhage on non-contrast computed tomography (NCCT) of the head. In subtle, acute cases, the capacity for DL algorithm image interpretation support might improve the diagnostic yield of CT for detection of this time-critical condition, potentially expediting treatment where appropriate and improving patient outcomes. However, there are multiple challenges to DL algorithm implementation, such as the relative scarcity of labeled datasets, the difficulties in developing algorithms capable of volumetric medical image analysis, and the complex practicalities of deployment into clinical practice. This review examines the literature and the approaches taken in the development of DL algorithms for the detection of intracranial hemorrhage on NCCT head studies. Considerations in crafting such algorithms will be discussed, as well as challenges which must be overcome to ensure effective, dependable implementations as automated tools in a clinical setting.

Advanced natural language processing technique to predict patient disposition based on emergency triage notes.

OBJECTIVE: To demonstrate the potential of machine learning and capability of natural language processing (NLP) to predict disposition of patients based on triage notes in the ED. METHODS: A retrospective cohort of ED triage notes from St Vincent's Hospital (Melbourne) was used to develop a deep-learning algorithm that predicts patient disposition. Bidirectional Encoder Representations from Transformers, a recent language representation model developed by Google, was utilised for NLP. Eighty percent of the dataset was used for training the model and 20% was used to test the algorithm performance. Ktrain library, a wrapper for TensorFlow Keras, was employed to develop the model. RESULTS: The accuracy of the algorithm was 83% and the area under the curve was 0.88. Sensitivity, specificity, precision and F1-score of the algorithm were 72%, 86%, 56% and 63%, respectively. CONCLUSION: Machine learning and NLP can be together applied to the ED triage note to predict patient disposition with a high level of accuracy. The algorithm can potentially assist ED clinicians in early identification of patients requiring admission by mitigating the cognitive load, thus optimises resource allocation in EDs.

Geographic Service Delivery for Endovascular Clot Retrieval: Using Discrete Event Simulation to Optimize Resources.

BACKGROUND: Endovascular clot retrieval (ECR) is the standard of care for acute ischemic stroke caused by large vessel occlusion. Reducing stroke symptom onset to reperfusion time is associated with improved functional outcomes. This study aims to develop a computational model to predict and identify time-related outcomes of community stroke calls within a geographic area based on variable parameters to support planning and coordination of ECR services. METHODS: A discrete event simulation (DES) model to simulate and predict ECR service was designed using SimPy, a process-based DES framework written in Python. Geolocation data defined by the user, as well as that used by the model, were sourced using the Google Maps application programming interface. Variables were customized by the user on the basis of their local environment to provide more accurate prediction. RESULTS: A DES model can estimate the delay between the time that emergency services are notified of a potential stroke and potential cerebral reperfusion using ECR at a capable hospital. Variables can be adjusted to observe the effect of modifying each parameter input. By varying the percentage of stroke patients receiving ECR, we were able to define the levels at which our existing service begins to fail in service delivery and assess the effect of adding centers. CONCLUSIONS: This novel computational DES model can aid the optimization of delivery of a stroke service within a city, state, or country. By varying geographic, population, and other user-defined inputs, the model can be applied to any location worldwide.

Determination of the electrical impedance of neural tissue from its microscopic cellular constituents.

The electrical properties of neural tissue are important in a range of different applications in biomedical engineering and basic science. These properties are characterized by the electrical admittivity of the tissue, which is the inverse of the specific tissue impedance. OBJECTIVE: Here we derived analytical expressions for the admittivity of various models of neural tissue from the underlying electrical and morphological properties of the constituent cells. APPROACH: Three models are considered: parallel bundles of fibers, fibers contained in stacked laminae and fibers crossing each other randomly in all three-dimensional directions. MAIN RESULTS: An important and novel aspect that emerges from considering the underlying cellular composition of the tissue is that the resulting admittivity has both spatial and temporal frequency dependence, a property not shared with conventional conductivity-based descriptions. The frequency dependence of the admittivity results in non-trivial spatiotemporal filtering of electrical signals in the tissue models. These effects are illustrated by considering the example of pulsatile stimulation with a point source electrode. It is shown how changing temporal parameters of a current pulse, such as pulse duration, alters the spatial profile of the extracellular potential. In a second example, it is shown how the degree of electrical anisotropy can change as a function of the distance from the electrode, despite the underlying structurally homogeneity of the tissue. These effects are discussed in terms of different current pathways through the intra- and extra-cellular spaces, and how these relate to near- and far-field limits for the admittivity (which reduce to descriptions in terms of a simple conductivity). SIGNIFICANCE: The results highlight the complexity of the electrical properties of neural tissue and provide mathematical methods to model this complexity.

Spin Lock Adiabatic Correction (SLAC) for B1-insensitive pulse design at 7T.

A new framework for B1 insensitive adiabatic pulse design is proposed, denoted Spin Lock Adiabatic Correction (SLAC), which counteracts deviations from ideal behaviour through inclusion of an additional correction component during pulse design. SLAC pulses are theoretically derived, then applied to the design of enhanced BIR-4 and hyperbolic secant pulses to demonstrate practical utility of the new pulses. At 7T, SLAC pulses are shown to improve the flip angle homogeneity compared to a standard adiabatic pulse with validation in both simulations and phantom experiments, under SAR equivalent experimental conditions. The SLAC framework can be applied to any arbitrary adiabatic pulse to deliver excitation with increased B1 insensitivity.

CODE STROKE ALERT-Concept and Development of a Novel Open-Source Platform to Streamline Acute Stroke Management.

Introduction: Effective, time-critical intervention in acute stroke is crucial to mitigate mortality rate and morbidity, but delivery of reperfusion treatments is often hampered by pre-, in-, or inter-hospital system level delays. Disjointed, repetitive, and inefficient communication is a consistent contributor to avoidable treatment delay. In the era of rapid reperfusion therapy for ischemic stroke, there is a need for a communication system to synchronize the flow of clinical information across the entire stroke journey. Material/Methods: A multi-disciplinary development team designed an electronic communications platform, integrated between web browsers and a mobile application, to link all relevant members of the stroke treatment pathway. The platform uses tiered notifications, geotagging, incorporates multiple clinical score calculators, and is compliant with security regulations. The system safely saves relevant information for audit and research. Results: Code Stroke Alert is a platform that can be accessed by emergency medical services (EMS) and hospital staff, coordinating the flow of information during acute stroke care, reducing duplication, and error in clinical information handover. Electronic data logs provide an auditable trail of relevant quality improvement metrics, facilitating quality improvement, and research. Discussion: Code Stroke Alert will be freely available to health networks globally. The open-source nature of the software offers valuable potential for future development of plug-ins and add-ons, based on individual institutional needs. Prospective, multi-site implementation, and measurement of clinical impact are underway.

Minimizing activation of overlying axons with epiretinal stimulation: The role of fiber orientation and electrode configuration.

Currently, a challenge in electrical stimulation of the retina with a visual prosthesis (bionic eye) is to excite only the cells lying directly under the electrode in the ganglion cell layer, while avoiding excitation of axon bundles that pass over the surface of the retina in the nerve fiber layer. Stimulation of overlying axons results in irregular visual percepts, limiting perceptual efficacy. This research explores how differences in fiber orientation between the nerve fiber layer and ganglion cell layer leads to differences in the electrical activation of the axon initial segment and axons of passage. APPROACH: Axons of passage of retinal ganglion cells in the nerve fiber layer are characterized by a narrow distribution of fiber orientations, causing highly anisotropic spread of applied current. In contrast, proximal axons in the ganglion cell layer have a wider distribution of orientations. A four-layer computational model of epiretinal extracellular stimulation that captures the effect of neurite orientation in anisotropic tissue has been developed using a volume conductor model known as the cellular composite model. Simulations are conducted to investigate the interaction of neural tissue orientation, stimulating electrode configuration, and stimulation pulse duration and amplitude. MAIN RESULTS: Our model shows that simultaneous stimulation with multiple electrodes aligned with the nerve fiber layer can be used to achieve selective activation of axon initial segments rather than passing fibers. This result can be achieved while reducing required stimulus charge density and with only modest increases in the spread of activation in the ganglion cell layer, and is shown to extend to the general case of arbitrary electrode array positioning and arbitrary target volume. SIGNIFICANCE: These results elucidate a strategy for more targeted stimulation of retinal ganglion cells with experimentally-relevant multi-electrode geometries and achievable stimulation requirements.

A computational model of orientation-dependent activation of retinal ganglion cells.

Currently, a challenge in electrical stimulation for epiretinal prostheses is the avoidance of stimulation of axons of passage in the nerve fiber layer that originate from distant regions of the ganglion cell layer. A computational model of extracellular stimulation that captures the effect of neurite orientation in anisotropic tissue is developed using a modified version of the standard volume conductor model, known as the cellular composite model, embedded in a four layer model of the retina. Simulations are conducted to investigate the interaction of neural tissue orientation, electrode placement, and stimulation pulse duration and amplitude. Using appropriate multiple electrode configurations and higher frequency stimulation, preferential activation of the axon initial segment is shown to be possible for a range of realistic electrode-retina separation distances. These results establish a quantitative relationship between the time-course of stimulation and physical properties of the tissue, such as fiber orientation.

Solving the Bloch equation with periodic excitation using harmonic balancing: application to Rabi modulated excitation.

In waveform design for magnetic resonance applications, periodic continuous-wave excitation offers potential advantages that remain largely unexplored because of a lack of understanding of the Bloch equation with periodic continuous-wave excitations. Using harmonic balancing techniques the steady state solutions of the Bloch equation with periodic excitation can be effectively solved. Moreover, the convergence speed of the proposed series approximation is such that a few terms in the series expansion suffice to obtain a very accurate description of the steady state solution. The accuracy of the proposed analytic approximate series solution is verified using both a simulation study as well as experimental data derived from a spherical phantom with doped water under continuous-wave excitation. Typically a five term series suffices to achieve a relative error of less than one percent, allowing for a very effective and efficient analytical design process. The opportunities for Rabi frequency modulated continuous-wave form excitation are then explored, based on a comparison with steady state free precession pulse sequences.

Characteristics of preceding Ia activity on postactivation depression in health and disease.

Previous activation of the soleus Ia afferents causes a depression in the amplitude of the H-reflex. This mechanism is referred to as postactivation depression (PAD) and is suggested to be presynaptically mediated. With the use of a paired reflex depression paradigm (eliciting two H-reflexes with conditioning-test intervals from 80 ms to 300 ms), PAD was examined in a group of healthy individuals and a group of hemiplegic patients. Healthy individuals showed substantial depression of the test H-reflex at all intervals. Although the patient group showed substantially less depression at all intervals, increasing the interval between the two reflexes sharply reduced the depression. In a separate experiment, we varied the size of the conditioning H-reflex against a constant test H-reflex. In healthy individuals, by increasing the size of the conditioning H-reflex, the amplitude of the test H-reflex exponentially decreased. In the patient group, however, this pattern was dependent on the conditioning-test interval; increasing the size of the conditioning H-reflex caused an exponential decrease in the size of the test reflex at intervals shorter than 150 ms. This pattern was similar to that of healthy individuals. However, conducting the same protocol at a longer interval (300 ms) in these patients resulted in an abnormal pattern (instead of an exponential decrease in the size of the test reflex, exaggerated responses were observed). Fisher discriminant analysis suggested that these two patterns (which differed only in the timing between the two stimuli) were substantially different from each other. Therefore, it is suggested that the abnormal pattern of PAD in hemiplegic stroke patients could be a contributing factor for the pathophysiology of spasticity.

Modelling extracellular electrical stimulation: part 3. Derivation and interpretation of neural tissue equations.

OBJECTIVE: A common approach in modelling extracellular electrical stimulation is to represent neural tissue by a volume conductor when calculating the activating function as the driving term in a cable equation for the membrane potential. This approach ignores the cellular composition of tissue, including the neurites and their combined effect on the extracellular potential. This has a number of undesirable consequences. First, the two natural and equally valid choices of boundary conditions for the cable equation (i.e. using either voltage or current) lead to two mutually inconsistent predictions of the membrane potential. Second, the spatio-temporal distribution of the extracellular potential can be strongly affected by the combined cellular composition of the tissue. In this paper, we develop a mean field volume conductor theory to overcome these shortcomings of available models. APPROACH: This method connects the microscopic properties of the constituent fibres to the macroscopic electrical properties of the tissue by introducing an admittivity kernel for the neural tissue that is non-local, non-instantaneous and anisotropic. This generalizes the usual tissue conductivity. A class of bidomain models that is mathematically equivalent to this class of self-consistent volume conductor models is also presented. The bidomain models are computationally convenient for simulating the activation map of neural tissue using numerical methods such as finite element analysis. MAIN RESULTS: The theory is first developed for tissue composed of identical, parallel fibres and then extended to general neural tissues composed of mixtures of neurites with different and arbitrary orientations, arrangements and properties. Equations describing the extracellular and membrane potential for the longitudinal and transverse modes of stimulation are derived. SIGNIFICANCE: The theory complements our earlier work, which developed extensions to cable theory for the micro-scale equations of neural stimulation that apply to individual fibres. The modelling framework provides a number of advantages over other approaches currently adopted in the literature and, therefore, can be used to accurately estimate the membrane potential generated by extracellular electrical stimulation.

Modelling extracellular electrical stimulation: part 4. Effect of the cellular composition of neural tissue on its spatio-temporal filtering properties.

OBJECTIVE: The objective of this paper is to present a concrete application of the cellular composite model for calculating the membrane potential, described in an accompanying paper. APPROACH: A composite model that is used to determine the membrane potential for both longitudinal and transverse modes of stimulation is demonstrated. MAIN RESULTS: Two extreme limits of the model, near-field and far-field for an electrode close to or distant from a neuron, respectively, are derived in this paper. Results for typical neural tissue are compared using the composite, near-field and far-field models as well as the standard isotropic volume conductor model. The self-consistency of the composite model, its spatial profile response and the extracellular potential time behaviour are presented. The magnitudes of the longitudinal and transverse components for different values of electrode-neurite separations are compared. SIGNIFICANCE: The unique features of the composite model and its simplified versions can be used to accurately estimate the spatio-temporal response of neural tissue to extracellular electrical stimulation.

Rabi resonance in spin systems: theory and experiment.

The response of a magnetic resonance spin system is predicted and experimentally verified for the particular case of a continuous wave amplitude modulated radiofrequency excitation. The experimental results demonstrate phenomena not previously observed in magnetic resonance systems, including a secondary resonance condition when the amplitude of the excitation equals the modulation frequency. This secondary resonance produces a relatively large steady state magnetisation with Fourier components at harmonics of the modulation frequency. Experiments are in excellent agreement with the theoretical prediction derived from the Bloch equations, which provides a sound theoretical framework for future developments in NMR spectroscopy and imaging.

Electrical stimulation of neural tissue modeled as a cellular composite: point source electrode in an isotropic tissue.

Standard volume conductor models of neural electrical stimulation assume that the electrical properties of the tissue are well described by a conductivity that is smooth and homogeneous at a microscopic scale. However, neural tissue is composed of tightly packed cells whose membranes have markedly different electrical properties to either the intra- or extracellular space. Consequently, the electrical properties of tissue are highly heterogeneous at the microscopic scale: a fact not accounted for in standard volume conductor models. Here we apply a recently developed framework for volume conductor models that accounts for the cellular composition of tissue. We consider the case of a point source electrode in tissue comprised of neural fibers crossing each other equally in all directions. We derive the tissue admittivity (that replaces the standard tissue conductivity) from single cell properties, and then calculate the extracellular potential. Our findings indicate that the cellular composition of tissue affects the spatiotemporal profile of the extracellular potential. In particular, the full solution asymptotically approaches a near-field limit close to the electrode and a far-field limit far from the electrode. The near-field and far-field approximations are solutions to standard volume conductor models, but differ from each other by nearly an order or magnitude. Consequently the full solution is expected to provide a more accurate estimate of electrical potentials over the full range of electrode-neurite separations.

Internal inconsistencies in models of electrical stimulation in neural tissue.

Calculating the membrane potential of a neurite under extracellular electrical stimulation is important in the design of some recent stimulation strategies for neuroprosthetic devices including retinal implants, cochlear implants, deep brain stimulation. A common approach, widely used in the electrical stimulation literature uses a volume conductor model to calculate the electrical potential in the tissue and then extracts the voltage or current density on the surface of a neuron, which is used as input to the cable equation to calculate the neuron's response. However this approach ignores the effect of the neuron itself as well as surrounding neurons on the extracellular potential. Here we highlight that this leads to an internal inconsistency in the overall model because the result depends on whether the voltage or current density is used to calculate the neural response. The magnitude of this discrepancy is calculated for the example of a point source electrode in a homogeneous medium and is shown to be up to several hundred percent under some stimulus conditions. The inconsistency can be resolved by ensuring that the voltage is related to the current density by the transimpedance of the neurite. Deriving a volume conductor model that satisfies this relationship requires further work.