A smart trocar for automatic tool recognition in laparoscopic surgery.

BACKGROUND: Operating rooms have become increasingly complex environments and more prone to errors because of loss of situation awareness. Adding computer intelligence to the operating room may help overcome these limitations particularly if the system can automatically track which step of an operation a surgeon is performing. To develop such a platform, it is necessary to track which laparoscopic instruments are being used and in which port they are inserted. This article describes the development and validation of a "Smart Trocar" that can automatically perform this function. METHODS: A Smart Trocar system prototype was developed that uses a wireless camera attached to a standard laparoscopic port and custom software algorithms. The system recognizes color wheels attached to the handle of a laparoscopic instrument and compares the unique color pattern to an instrument library for proper tool identification. The system was tested for reliability in a box trainer environment using a variety of tool positions and levels of room light illumination. RESULTS: Correct color classification was achieved in 96.7% of trials. There were no errors in detection of the color wheel in space. In addition, the distance of the color wheel from the camera did not influence results and correct classifications were evenly distributed among the 12 laparoscopic tool positions tested. CONCLUSION: This work describes a Smart Trocar system that identifies which laparoscopic tool is being used and in which port and proves its reliability. The system is an important element of a more comprehensive program being developed to automatically understand what step of an operation a surgeon is performing and use these data to improve situation awareness in the operating room.

Computer Science Students' Perceptions of Emergency Remote Teaching: An Experience Report.

In the first 6 months of 2020, the COVID-19 pandemic forced numerous universities across the globe to quickly transfer all their courses online, a response known as Emergency Remote Teaching. Courses initially designed for face to face delivery had to be quickly adapted to a new online format. In this paper, we study the perception of the transition to remote teaching in a group of computer science students. Despite the advantage given by an average higher computer literacy, the results of this study suggest that students found the transition challenging, especially regarding tasks such as asking questions during video lectures and interacting with instructors. The transition seems to have had a greater impact on students of lower level courses. Differences were found also across race and residence status (but not gender). The initial format of the course was also relevant: students fared better if their course relied on online tools before the transition.

PD-1 suppresses the maintenance of cell couples between cytotoxic T cells and target tumor cells within the tumor.

The killing of tumor cells by CD8+ T cells is suppressed by the tumor microenvironment, and increased expression of inhibitory receptors, including programmed cell death protein-1 (PD-1), is associated with tumor-mediated suppression of T cells. To find cellular defects triggered by tumor exposure and associated PD-1 signaling, we established an ex vivo imaging approach to investigate the response of antigen-specific, activated effector CD8+ tumor-infiltrating lymphocytes (TILs) after interaction with target tumor cells. Although TIL-tumor cell couples readily formed, couple stability deteriorated within minutes. This was associated with impaired F-actin clearing from the center of the cellular interface, reduced Ca2+ signaling, increased TIL locomotion, and impaired tumor cell killing. The interaction of CD8+ T lymphocytes with tumor cell spheroids in vitro induced a similar phenotype, supporting a critical role of direct T cell-tumor cell contact. Diminished engagement of PD-1 within the tumor, but not acute ex vivo blockade, partially restored cell couple maintenance and killing. PD-1 thus contributes to the suppression of TIL function by inducing a state of impaired subcellular organization.

SemEHR: A general-purpose semantic search system to surface semantic data from clinical notes for tailored care, trial recruitment, and clinical research.

Objective: Unlocking the data contained within both structured and unstructured components of electronic health records (EHRs) has the potential to provide a step change in data available for secondary research use, generation of actionable medical insights, hospital management, and trial recruitment. To achieve this, we implemented SemEHR, an open source semantic search and analytics tool for EHRs. Methods: SemEHR implements a generic information extraction (IE) and retrieval infrastructure by identifying contextualized mentions of a wide range of biomedical concepts within EHRs. Natural language processing annotations are further assembled at the patient level and extended with EHR-specific knowledge to generate a timeline for each patient. The semantic data are serviced via ontology-based search and analytics interfaces. Results: SemEHR has been deployed at a number of UK hospitals, including the Clinical Record Interactive Search, an anonymized replica of the EHR of the UK South London and Maudsley National Health Service Foundation Trust, one of Europe's largest providers of mental health services. In 2 Clinical Record Interactive Search-based studies, SemEHR achieved 93% (hepatitis C) and 99% (HIV) F-measure results in identifying true positive patients. At King's College Hospital in London, as part of the CogStack program (github.com/cogstack), SemEHR is being used to recruit patients into the UK Department of Health 100 000 Genomes Project (genomicsengland.co.uk). The validation study suggests that the tool can validate previously recruited cases and is very fast at searching phenotypes; time for recruitment criteria checking was reduced from days to minutes. Validated on open intensive care EHR data, Medical Information Mart for Intensive Care III, the vital signs extracted by SemEHR can achieve around 97% accuracy. Conclusion: Results from the multiple case studies demonstrate SemEHR's efficiency: weeks or months of work can be done within hours or minutes in some cases. SemEHR provides a more comprehensive view of patients, bringing in more and unexpected insight compared to study-oriented bespoke IE systems. SemEHR is open source, available at https://github.com/CogStack/SemEHR.

Neuropsychological benefits of a narrative cognitive training program for people living with dementia: A pilot study.

Many areas in the cortex are active during reading of narrative material, and these activations in the brain produce significant changes in connectivity. Following previous results showing cognitive benefits in memory domains of a narrative training program in nursing home patients living with dementia, the aim of the present study was to perform a more in depth investigation of the effects of this training on memory domains and other cognitive areas. METHODS: An experimental group of eight patients underwent auditory narrative training of 60 hours. At the beginning and end of the training, subjects were tested with a neuropsychological battery to quantify any improvements in individual performance. RESULTS: The results showed a statistically significant improvement in the list learning task (immediate memory) and list learning recognition for single tasks, and a statistically significant improvement in overall cognitive area scores for immediate and delayed memory. CONCLUSION: Results replicate and expand our previous findings, indicating that this type of intervention can increase performance on memory-related tests.

Muitas áreas no córtex são ativos durante a leitura do material narrativa, e essas ativações no cérebro podem produzir mudanças significativas na conectividade. Na sequência dos resultados anteriores mostrando os benefícios cognitivos em domínios de memória de um programa de treinamento narrativa em pacientes do lar de idosos que vivem com demência, o objetivo do presente estudo foi realizar uma investigação mais aprofundada dos efeitos desta formação sobre os domínios de memória e outras áreas cognitivas. MÉTODOS: Um grupo experimental de oito pacientes foram submetidos a treinamento narrativa auditivo de 60 horas. No início e no final do treinamento, os participantes foram testados com uma bateria neuropsicológica para quantificar quaisquer melhorias no desempenho individual. RESULTADOS: Os resultados mostraram uma melhoria estatisticamente significativa na tarefa lista de aprendizagem (memória imediata) e reconhecimento lista de aprendizagem para tarefas individuais e uma melhoria estatisticamente significativa na pontuação da área cognitivas gerais para a memória imediata e tardia. CONCLUSÃO: Replicar os resultados e expandir nossas descobertas anteriores, indicando que este tipo de intervenção pode aumentar o desempenho em testes relacionados à memória.

Analysis of correlation between pediatric asthma exacerbation and exposure to pollutant mixtures with association rule mining.

OBJECTIVES: Traditional studies on effects of outdoor pollution on asthma have been criticized for questionable statistical validity and inefficacy in exploring the effects of multiple air pollutants, alone and in combination. Association rule mining (ARM), a method easily interpretable and suitable for the analysis of the effects of multiple exposures, could be of use, but the traditional interest metrics of support and confidence need to be substituted with metrics that focus on risk variations caused by different exposures. METHODS: We present an ARM-based methodology that produces rules associated with relevant odds ratios and limits the number of final rules even at very low support levels (0.5%), thanks to post-pruning criteria that limit rule redundancy and control for statistical significance. The methodology has been applied to a case-crossover study to explore the effects of multiple air pollutants on risk of asthma in pediatric subjects. RESULTS: We identified 27 rules with interesting odds ratio among more than 10,000 having the required support. The only rule including only one chemical is exposure to ozone on the previous day of the reported asthma attack (OR=1.14). 26 combinatory rules highlight the limitations of air quality policies based on single pollutant thresholds and suggest that exposure to mixtures of chemicals is more harmful, with odds ratio as high as 1.54 (associated with the combination day0 SO2, day0 NO, day0 NO2, day1 PM). CONCLUSIONS: The proposed method can be used to analyze risk variations caused by single and multiple exposures. The method is reliable and requires fewer assumptions on the data than parametric approaches. Rules including more than one pollutant highlight interactions that deserve further investigation, while helping to limit the search field.

Neuropsychological benefits of a narrative cognitive training program for people living with dementia: A pilot study / Benefícios neuropsicológicos de um programa de formação cognitiva narrativa para pessoas que vivem com demência: um estudo piloto

ABSTRACT Many areas in the cortex are active during reading of narrative material, and these activations in the brain produce significant changes in connectivity. Following previous results showing cognitive benefits in memory domains of a narrative training program in nursing home patients living with dementia, the aim of the present study was to perform a more in depth investigation of the effects of this training on memory domains and other cognitive areas. Methods: An experimental group of eight patients underwent auditory narrative training of 60 hours. At the beginning and end of the training, subjects were tested with a neuropsychological battery to quantify any improvements in individual performance. Results: The results showed a statistically significant improvement in the list learning task (immediate memory) and list learning recognition for single tasks, and a statistically significant improvement in overall cognitive area scores for immediate and delayed memory. Conclusion: Results replicate and expand our previous findings, indicating that this type of intervention can increase performance on memory-related tests.

RESUMO Muitas áreas no córtex são ativos durante a leitura do material narrativa, e essas ativações no cérebro podem produzir mudanças significativas na conectividade. Na sequência dos resultados anteriores mostrando os benefícios cognitivos em domínios de memória de um programa de treinamento narrativa em pacientes do lar de idosos que vivem com demência, o objetivo do presente estudo foi realizar uma investigação mais aprofundada dos efeitos desta formação sobre os domínios de memória e outras áreas cognitivas. Métodos: Um grupo experimental de oito pacientes foram submetidos a treinamento narrativa auditivo de 60 horas. No início e no final do treinamento, os participantes foram testados com uma bateria neuropsicológica para quantificar quaisquer melhorias no desempenho individual. Resultados: Os resultados mostraram uma melhoria estatisticamente significativa na tarefa lista de aprendizagem (memória imediata) e reconhecimento lista de aprendizagem para tarefas individuais e uma melhoria estatisticamente significativa na pontuação da área cognitivas gerais para a memória imediata e tardia. Conclusão: Replicar os resultados e expandir nossas descobertas anteriores, indicando que este tipo de intervenção pode aumentar o desempenho em testes relacionados à memória.