TEsoNet: knowledge transfer in surgical phase recognition from laparoscopic sleeve gastrectomy to the laparoscopic part of Ivor-Lewis esophagectomy.

BACKGROUND: Surgical phase recognition using computer vision presents an essential requirement for artificial intelligence-assisted analysis of surgical workflow. Its performance is heavily dependent on large amounts of annotated video data, which remain a limited resource, especially concerning highly specialized procedures. Knowledge transfer from common to more complex procedures can promote data efficiency. Phase recognition models trained on large, readily available datasets may be extrapolated and transferred to smaller datasets of different procedures to improve generalizability. The conditions under which transfer learning is appropriate and feasible remain to be established. METHODS: We defined ten operative phases for the laparoscopic part of Ivor-Lewis Esophagectomy through expert consensus. A dataset of 40 videos was annotated accordingly. The knowledge transfer capability of an established model architecture for phase recognition (CNN + LSTM) was adapted to generate a "Transferal Esophagectomy Network" (TEsoNet) for co-training and transfer learning from laparoscopic Sleeve Gastrectomy to the laparoscopic part of Ivor-Lewis Esophagectomy, exploring different training set compositions and training weights. RESULTS: The explored model architecture is capable of accurate phase detection in complex procedures, such as Esophagectomy, even with low quantities of training data. Knowledge transfer between two upper gastrointestinal procedures is feasible and achieves reasonable accuracy with respect to operative phases with high procedural overlap. CONCLUSION: Robust phase recognition models can achieve reasonable yet phase-specific accuracy through transfer learning and co-training between two related procedures, even when exposed to small amounts of training data of the target procedure. Further exploration is required to determine appropriate data amounts, key characteristics of the training procedure and temporal annotation methods required for successful transferal phase recognition. Transfer learning across different procedures addressing small datasets may increase data efficiency. Finally, to enable the surgical application of AI for intraoperative risk mitigation, coverage of rare, specialized procedures needs to be explored.

Serotypes and virutypes of enteropathogenic and enterohaemorrhagic Escherichia coli strains from stool samples of children with diarrhoea in Germany.

AIMS: To investigate the prevalence of traditional and emerging types of enteropathogenic (EPEC) and enterohaemorrhagic Escherichia coli (EHEC) strains in stool samples from children with diarrhoea and to characterize their virulence genes involved in the attaching and effacing (A/E) phenotype. METHODS AND RESULTS: Serological and PCR-based methods were used for detection and isolation of EPEC and EHEC strains from 861 stool samples from diarrhoeic children. Agglutination with traditional EPEC and EHEC O-group-specific antisera resulted in detection of 38 strains; 26 of these carried virulence factors of EPEC or EHEC. PCR screening for the eae gene resulted in isolation of 97 strains, five carried genes encoding Shiga toxins (stx), one carried the bfpA gene and 91 were atypical EPEC. The 97 EPEC and EHEC strains were divided into 36 O-serogroups and 21 H-types, only nine strains belonged to the traditional EPEC O-groups O26, O55, O86 and O128. In contrast, EPEC serotypes O28:H28, O51:H49, O115:H38 and O127:H40 were found in multiple cases. Subtyping the virulence factors intimin, Tir and Tir-cytoskeleton coupling effector protein (TccP)/TccP2 resulted in further classification of 93.8% of the 97 strains. CONCLUSIONS: Our findings show a clear advantage of the eae-PCR over the serological detection method for identification of EPEC and EHEC strains from human patients. SIGNIFICANCE AND IMPACT OF THE STUDY: Molecular detection by the eae-PCR followed by serotyping and virutyping is useful for monitoring trends in EPEC and EHEC infections and to discover their possible reservoirs.

Biomass Increases Go under Cover: Woody Vegetation Dynamics in South African Rangelands.

Woody biomass dynamics are an expression of ecosystem function, yet biomass estimates do not provide information on the spatial distribution of woody vegetation within the vertical vegetation subcanopy. We demonstrate the ability of airborne light detection and ranging (LiDAR) to measure aboveground biomass and subcanopy structure, as an explanatory tool to unravel vegetation dynamics in structurally heterogeneous landscapes. We sampled three communal rangelands in Bushbuckridge, South Africa, utilised by rural communities for fuelwood harvesting. Woody biomass estimates ranged between 9 Mg ha(-1) on gabbro geology sites to 27 Mg ha(-1) on granitic geology sites. Despite predictions of woodland depletion due to unsustainable fuelwood extraction in previous studies, biomass in all the communal rangelands increased between 2008 and 2012. Annual biomass productivity estimates (10-14% p.a.) were higher than previous estimates of 4% and likely a significant contributor to the previous underestimations of modelled biomass supply. We show that biomass increases are attributable to growth of vegetation <5 m in height, and that, in the high wood extraction rangeland, 79% of the changes in the vertical vegetation subcanopy are gains in the 1-3 m height class. The higher the wood extraction pressure on the rangelands, the greater the biomass increases in the low height classes within the subcanopy, likely a strong resprouting response to intensive harvesting. Yet, fuelwood shortages are still occurring, as evidenced by the losses in the tall tree height class in the high extraction rangeland. Loss of large trees and gain in subcanopy shrubs could result in a structurally simple landscape with reduced functional capacity. This research demonstrates that intensive harvesting can, paradoxically, increase biomass and this has implications for the sustainability of ecosystem service provision. The structural implications of biomass increases in communal rangelands could be misinterpreted as woodland recovery in the absence of three-dimensional, subcanopy information.

Effects of nutrients on the distribution of dry mass, nitrogen and phosphorus in seedlings of Protea repens (L.) L. (Proteaceae).

The response of seedlings of the sclerophyllous shrub, Protea repens (L.) 1., to increasing concentrations of phosphorus (P), nitrogen (N) and a mixture of all essential nutrients excluding N and P (M) was determined in potted Clovelly soil collected Irotn a lowland fynbos site at pella, south-western Cape, South Africa. Pot culture resulted in increased soil mineral nitrogen, in particular nitrate, and decreased available (resin-extractable) phosphorus concentrations compared to field soil. High amounts of N (4-64 g m2 N) and M addition resulted in seedling mortality. Plant dry mass, leaf area and phosphorus and nitrogen contents increased in response to increasing application of N, but no significant differences were found in response to M. Increasing applications of N resulted in reduced plant dry mass, leaf area and phosphorus content. These patterns of mortality and growth are interpreted as a response to an imbalance between nitrogen and phosphorus availability. These results are compared to the response of mature fynbos shrubs to fertilizer additions in the field and the responses of pot-sclerophyllous plants from other Mediterranean-type ecosystems.

Leaf specific mass confounds leaf density and thickness.

We explored the relationship between leaf specific mass (LSM) and its two components, leaf density and thickness. These were assessed on the leaves of (a) the moderately sclerophyllous tree Arbutus menziesii distributed along a natural nutrient/moisture gradient in California, (b) eight sclerophyllous shrub species on four substrates in south-western Australia, and (c) seedlings of two morphologically contrasting Hakea species grown under varying soil nutrient, moisture and light regimes in a glasshouse experiment. Leaf area, mass, LSM, density and thickness varied greatly between leaves on the same plant, different species, and with different nutrient, moisture and light regimes. In some cases, variations in LSM were due to changes in leaf density in particular or thickness or both, while in others, density and thickness varied without a net effect on LSM. At lower nutrient or moisture availabilities or at higher light irradiances, leaves tended to be smaller, with higher LSM, density and thickness. Under increased stress, the thickness (diameter) of needle leaves decreased despite an increase in LSM. We concluded that, while LSM is a useful measure of sclerophylly, its separation into leaf density and thickness may be more appropriate as they often vary independently and appear to be more responsive to environmental gradients than LSM.

Disproportionate allocation of mineral nutrients and carbon between vegetative and reproductive structures in Banksia hookeriana.

We compared above-ground allocation patterns in mature shrubs of Banksia hookeriana from three 13-year-old populations, growing on nutrient-impoverished sands to determine whether C (dry mass) could be a substitute for mineral nutrients (N, P, K, Ca, Mg and NA). The percentage of reproductive structures to total above-ground growth (reproductive effort; RE) was integrated over nine successive reproductive cycles. Only 0.5% of above-ground dry mass was allocated to seeds compared with 31% to total RE. Allocations of N (24%) and P (48%) to seeds, and N (44%) and P (65%) to RE were much higher. Allocations of K, Ca, Mg and Na to seeds (<1-3%), and RE (21-35%) were closer to that of dry mass. Relative allocation (RA) is defined as the proportion of a nutrient element allocated to a structure relative to its dry mass. RA of P to seeds was 91 and N was 44, but for K, Ca, Mg and Na ranged from only 6 for K to<1 for Na. Thus P, and to a lesser extent N, provide a much more sensitive measure of the relative cost of reproduction than C in this nutrient-limited system.

A test for lottery recruitment among four Banksia species based on their demography and biological attributes.

A stage-by-stage protocol for identifying simple or biased lottery, or non-lottery, patterns of seedling recruitment is outlined. For a simple (weighted) lottery to apply, the proportion of total individuals accounted for by one species at one stage of recruitment plotted against the proportion accounted for at a previous stage over a wide range of recruitment conditions should obey a linear regression with a=0 and b=1. For a biased lottery to hold, the regression is significant but a≠0 and/or b≠1. Demorgraphic, size and water relations data were collected over 3 years for four co-occurring Banksia species following two contrasting experimental fires. The first summer was exceptionally wet and the second was exceptionally hot and dry. Seedlings still alive by the 3rd year relative to the fire-killed parent plants conformed to a biased lottery in the case of B. speciosa and B. baxteri, while B. coccinea and B. pulchella had no mathematical structure (mean of the proportional ratios ≠ 1). Intervening stages, beginning with seed release, showed transient deterministic or simple lottery patterns in some cases, but the overriding trend was for biased lotteries. B. speciosa dominated the responses, with greater seed release than expected, fewer initial seedlings, lottery survival of 1st year seedlings and greater survival of 2nd year seedlings, when compared with the previous stages. Large seeds and subsequent high growth rates enabled B. speciosa to exploit soil water preferentially during the severe summer drought. The trend for B. speciosa to replace other species may be cancelled by stochastic processes not operating in this particular study.

Population fragmentation may reduce fertility to zero in Banksia goodii - a demonstration of the Allee effect.

All individuals of all known populations of Banksia goodii were assessed for seed production. Small populations produced no or only a few seeds per unit canopy area. Effects of population size on seed production per unit area and seed production per plant were present over the whole range of population sizes, indicating that even in large populations seed production may still not be at its maximum. Resource differences could not explain this disproportionate decrease in seed production with decline in population size, because there were no differences in soil properties and understorey or overstorey cover between the small and large populations. Although plants in small and large populations were similar in size, seed production per plant was much lower in small populations. This was not because plants in small populations produced fewer cones but because the fraction of these cones that was fertile was much lower. Five of the nine smallest populations (<200 m2) produced no fertile cones over the last 10 years. The number of seeds per fertile cone did not depend on population size. The results are discussed in relation to pollination biology.

The need for care co-ordination in an ageing dialysis population.

Over the past ten year period, there has been a sharp increase in the age distribution of dialysis patients. The mean age of patients entering dialysis therapy in 1995 was 69 years, rising to 75 years by 2005 (Figure 1). Of this group of patients, there is a 20% mortality rate within 6 months of commencing dialysis (Figure 2). Renal replacement therapy (RRT) is considered a bridge to transplantation. However, what if the patient is not eligible for transplantation because of age, co-morbidity or refusal?

Conceptualizing the human use of wild edible herbs for conservation in South African communal areas.

The importance of wild edible herbaceous species to resource poor households in most rural economies within savannas has been little studied. This is because most of the herbs grow in impoverished species communities and lands, often referred to as 'marginal lands'. The aim of this paper is to conceptualize how the economics of wild edible herbs to households can be used to add value to total livelihoods and conservation within traditional communal areas of South Africa. Analysis of the economics of the consumption of wild edible herbs in Thorndale (Bushbuckridge district) of the Limpopo province is presented. The majority of households consumed wild edible herbs, averaging 15.4 kg dried weight per household per year and valued at $167 per household. The herbs were mostly harvested from uncultivated areas of farms, and rangelands. There was little correlation between household characteristics and the dependence on wild herbs for food. The local people noted a decline in the availability of the species, although not much is known about attempts to cultivate them. The only reasons attributed to the decline were nutrient poor soils and insufficient rains. With this background, developing a local strategy to sustain the species through cultivation by households was found to be feasible. A multiple-use system for the herbs, their improvement and value addition towards commercialization and increased household usage may result in wider acceptance and subsequent cultivation. Species diversity will be enhanced whilst conserving the land on which they grow. This multiple use system may include species roles in soil and water conservation.

A landscape ecological approach to address scaling problems in conservation management and monitoring.

Management of many African game reserves is today often still an art based on experience and intuition, rather than a science. Decision-making is based on an informal integration of accumulated individual knowledge and keen field observations. Data are generally poorly captured and curated. Until fairly recently, denominators of biological parameters (such as the unit of land or unit of plant production used as measurement) have generally been treated as being homogenous. The patchiness of landscapes and the issue of ecological scaling were ignored, often because of a lack of appropriate technical tools. The ecological data available on the 49,000-ha Songimvelo Game Reserve (SGR) result from a number of discrete survey and monitoring projects undertaken by different researchers, with different objectives, at different spatial and temporal scales. A landscape ecological approach towards research and monitoring is appropriate for an area of the size and diversity of the SGR. A combination of a database approach and spatial representation was used to consolidate and integrate data across temporal and spatial scales. Herbivore spatial and temporal distribution patterns were explored across three spatial scales. An understanding was achieved of the importance of landscape patchiness in controlling resource availability for herbivores. This insight is important in guiding management and monitoring of the SGR by placing perceived patch overutilization in its proper landscape context. The landscape ecological approach bridges the traditional scale-independent view to a more contemporary scale-related understanding of ecosystem diversity and functioning.

Sublabral recess of the superior glenoid labrum: study of cadavers with conventional nonenhanced MR imaging, MR arthrography, anatomic dissection, and limited histologic examination.

PURPOSE: To evaluate size, location, and appearance of the sublabral recess of the superior glenoid labrum, which mimics a superior labral tear oriented in the anterior to posterior direction (SLAP) lesion with conventional magnetic resonance (MR) imaging, MR arthrography, gross dissection, and limited histologic evaluation. MATERIALS AND METHODS: Twenty-six cadaveric shoulder specimens that were freshly frozen were examined with nonenhanced MR imaging and with MR arthrography after intraarticular injection of dilute contrast material with gadolinium. In all specimens, the appearance of the superior glenolabral junction was categorized and was correlated to that seen at gross anatomic dissection. Histologic sections were obtained of two shoulders with large sublabral recesses in the plane of the MR sections. RESULTS: A sublabral recess was present in 19 (73%) shoulders and was deeper than 2 mm in 10 (39%). MR arthrography better demonstrated the sublabral recess than nonenhanced MR imaging. In 16 of 19 shoulders, the sublabral recess was located in the most anterior section obtained through the superior labrum. There was no definite correlation between subject age and sex and glenolabral junction type. At histologic examination of the two shoulders, a synovial lining of the sublabral recess was seen and there was no evidence of fibrosis to suggest a traumatic cause. CONCLUSION: A sublabral recess is common in cadaveric shoulders and has an appearance similar to that of published examples of SLAP lesions. Histologic findings were consistent with normal anatomic structure rather than with acquired, posttraumatic lesions.