Machine learning methods for automated technical skills assessment with instructional feedback in ultrasound-guided interventions.

OBJECTIVE: Currently, there is a worldwide shift toward competency-based medical education. This necessitates the use of automated skills assessment methods during self-guided interventions training. Making assessment methods that are transparent and configurable will allow assessment to be interpreted into instructional feedback. The purpose of this work is to develop and validate skills assessment methods in ultrasound-guided interventions that are transparent and configurable. METHODS: We implemented a method based upon decision trees and a method based upon fuzzy inference systems for technical skills assessment. Subsequently, we validated these methods for their ability to predict scores of operators on a 25-point global rating scale in ultrasound-guided needle insertions and their ability to provide useful feedback for training. RESULTS: Decision tree and fuzzy rule-based assessment performed comparably to state-of-the-art assessment methods. They produced median errors (on a 25-point scale) of 1.7 and 1.8 for in-plane insertions and 1.5 and 3.0 for out-of-plane insertions, respectively. In addition, these methods provided feedback that was useful for trainee learning. Decision tree assessment produced feedback with median usefulness 7 out of 7; fuzzy rule-based assessment produced feedback with median usefulness 6 out of 7. CONCLUSION: Transparent and configurable assessment methods are comparable to the state of the art and, in addition, can provide useful feedback. This demonstrates their value in self-guided interventions training curricula.

A survey of medication preparation and administration practices among members of the Canadian Anesthesiologists' Society.

PURPOSE: Recommendations for safe medication injection practices to eliminate the risk of patient-to-patient transmission of blood-borne infections have been in place for many years. The purpose of our study was to evaluate the medication administration practices of Canadian anesthesiologists relative to current safe practice guidelines. METHODS: An anonymous 17-question online survey was sent to all members of the Canadian Anesthesiologists' Society (CAS) via the membership email list. Data pertaining to respondent demographics, practice characteristics, and medication preparation and administration practices were collected and analyzed descriptively using frequencies and percentages as well as Fisher's exact tests followed by post hoc multiple comparisons. RESULTS: Of the 2,656 CAS members, 546 (21%) responded. The practice of reusing needles (2%) and/or syringes (7%) between patients is reported by only a minority of practitioners; however, sharing a medication vial between more than one patient using new needles and syringes is still widely practiced with 83% doing this sometimes or routinely. The main reasons for sharing medications include the desire to reduce medication waste and the associated costs. CONCLUSION: Sharing medication vials between multiple patients is common practice in Canada, with new needles and syringes used for each patient. Unfortunately, a small minority of anesthesiologists continue to reuse needles and/or syringes between patients, and this may pose a significant risk of patient-to-patient infection transmission.

Cytosolic localization of Fox proteins in motor neurons of G93A SOD1 mice.

NeuN is a nuclear protein expressed exclusively in mature neurons and has served for many years as a reliable neuronal marker in immunohistochemical labeling studies. In 2009, NeuN was identified as Fox3, one of three closely related RNA binding proteins important in pre-mRNA splicing. During the course of a previous study using G93A SOD1 mice, a model of amyotrophic lateral sclerosis (ALS), we observed that NeuN was significantly redistributed to the cytosol. Since altered splicing may be important in the pathogenesis of ALS, we compared the localization (predominantly nuclear or cytosolic) of all three Fox proteins in the lumbar spinal cord of wild-type and G93A SOD1 mice before and after the development of clinical signs of disease. The Fox proteins regulate their own splicing, and we also examined the major Fox protein isoforms in nuclear and cytosolic fractions of lumbar spinal cord by Western blotting. We report here that Fox3 and Fox2 undergo a major cytosolic relocalization in this ALS model that increases with age and that is associated with progressive alterations in the splicing profiles of all three Fox proteins.

Enhanced electroluminescence based on thermally activated delayed fluorescence from a carbazole-triazine derivative.

Thermally activated delayed fluorescence (TADF) properties of a dicarbazole-triazine compound, 9-(4,6-diphenyl-1,3,5-triazin-2-yl)-9'-phenyl-3,3'-bicarbazole (CzT), and its OLED characteristics were investigated. An estimated small energy gap of about 90 meV between the singlet and triplet energy states of CzT made the up-conversion of triplet excitons back to a singlet state possible. The origin of the observed delayed fluorescence has been shown to be thermally activated delayed fluorescence. An organic light emitting diode (OLED) with CzT as an emitter showed the maximum external quantum efficiency (EQE) of 6%. For comparison, another carbazole-triazine derivative of 3-(2'-(4,6-diphenyl-1,3,5-triazin-2-yl)-[1,1'-biphenyl]-2-yl)-9-phenyl-9H-carbazole (PhCzTAZ) with a similar structure was also studied. PhCzTAZ showed a low fluorescence quantum yield with no TADF.