Decision tree accelerated CTU partition algorithm for intra prediction in versatile video coding.

Versatile video coding (VVC) achieves enormous improvement over the advanced high efficiency video coding (HEVC) standard due to the adoption of the quadtree with nested multi-type tree (QTMT) partition structure and other coding tools. However, the computational complexity increases dramatically as well. To tackle this problem, we propose a decision tree accelerated coding tree units (CTU) partition algorithm for intra prediction in VVC. Firstly, specially designated image features are extracted to characterize the coding unit (CU) complexity. Then, the trained decision tree is employed to predict the partition results. Finally, based on our newly designed intra prediction framework, the partition process is early terminated or redundant partition modes are screened out. The experimental results show that the proposed algorithm could achieve around 52% encoding time reduction for various test video sequences on average with only 1.75% Bjontegaard delta bit rate increase compared with the reference test model VTM9.0 of VVC.

Fertility and Sterility top videos from 2017 to 2019.

OBJECTIVE: To objectively grade all video publications in Fertility and Sterility during the years 2017-2019 and compile a list of the top 10 surgical videos. DESIGN: Descriptive presentation of the 10 highest-scoring video publications from Fertility and Sterility in the years 2017-2019. SETTING: Not applicable. PATIENT(S)/ANIMAL(S): Not applicable. INTERVENTION(S): All 4 authors acted as independent reviewers of all video publications. A standardized scoring method was used to score all videos. MAIN OUTCOME MEASURE(S): Up to 5 points were awarded for each of the following categories: Scientific merit or clinical relevance of the topic; clarity of video; use of innovative surgical technique; and video editing or use of marking tools on the video to highlight important features or surgical landmarks. This allowed a maximum score of 20 for each video. The number of YouTube views and likes were used as a tiebreaker if ≥2 videos scored similarly. The interclass coefficient from a 2-way random effects model was calculated to assess for agreement between the 4 independent reviewers. RESULT(S): A total of 40 videos were published in Fertility and Sterility during the years 2017-2019. After averaging scores from all 4 reviewers, a top 10 list was created (Table). Only 2 videos (number 6 and 7 spots) had the same average score, and the number of YouTube views and likes were used as a tiebreaker. The overall interclass coefficient for the 4 reviewers was 0.68 (95% confidence interval, 0.52-0.76). CONCLUSION(S): An overall substantial agreement was noted between the 4 reviewers. Ten videos reigned supreme from a list of very competitive publications that had already undergone the peer review process. The subject matter of these videos ranged from complex surgical procedures, including uterus transplantation and use of a biologic graft for neovaginoplasty, to common procedures like hysteroscopic removal of intrauterine devices during pregnancy and approaches to the stenotic cervix.

Long-term Home Video EEG for Recording Clinical Events.

SUMMARY: Around 50 years after the first EEG acquisition by Hans Berger, its use in ambulatory setting was demonstrated. Ever since, ambulatory EEG has been widely available and routinely used in the United States (and to a lesser extent in Europe) for diagnosis and management of patients with epilepsy. This technology alone cannot help with semiological characterization, and absence of video is one of its main drawbacks. Addition of video to ambulatory EEG potentially improves diagnostic yield and opens new aspects of utility for better characterization of patient's events, including differential diagnosis, classification, and quantification of seizure burden. Studies evaluating quality of ambulatory video EEG (aVEEG) suggest good quality recordings are feasible. In the utilization of aVEEG, to maximize yield, it is important to consider pretest probability. Having clear pretest questions and a strong index of suspicion for focal, generalized convulsive or non-epileptic seizures further increases the usefulness of aVEEG. In this article, which is part of the topical issue "Ambulatory EEG," the authors compare long-term home aVEEG to inpatient video EEG monitoring, discuss aVEEG's use in diagnosis and follow-up of patients, and present the authors' own experience of the utility of aVEEG in a teaching hospital setting.

Twenty-four-hour patterns in electrodermal activity recordings of patients with and without epileptic seizures.

OBJECTIVE: Daytime and nighttime patterns affect the dynamic modulation of brain and body functions and influence the autonomic nervous system response to seizures. Therefore, we aimed to evaluate 24-hour patterns of electrodermal activity (EDA) in patients with and without seizures. METHODS: We included pediatric patients with (a) seizures (SZ), including focal impaired awareness seizures (FIAS) or generalized tonic-clonic seizures (GTCS), (b) no seizures and normal electroencephalography (NEEG), or (c) no seizures but epileptiform activity in the EEG (EA) during vEEG monitoring. Patients wore a device that continuously recorded EDA and temperature (TEMP). EDA levels, EDA spectral power, and TEMP levels were analyzed. To investigate 24-hour patterns, we performed a nonlinear mixed-effects model analysis. Relative mean pre-ictal (-30 min to seizure onset) and post-ictal (I: 30 min after seizure offset; II: 30 to 60 min after seizure offset) values were compared for SZ subgroups. RESULTS: We included 119 patients (40 SZ, 17 NEEG, 62 EA). EDA level and power group-specific models (SZ, NEEG, EA) (h = 1; P < .01) were superior to the all-patient cohort model. Fifty-nine seizures were analyzed. Pre-ictal EDA values were lower than respective 24-hour modulated SZ group values. Post hoc comparisons following the period-by-seizure type interaction (EDA level: χ2  = 18.50; P < .001, and power: χ2  = 6.73; P = .035) revealed that EDA levels were higher in the post-ictal period I for FIAS and GTCS and in post-ictal period II for GTCS only compared to the pre-ictal period. SIGNIFICANCE: Continuously monitored EDA shows a pattern of change over 24 hours. Curve amplitudes in patients with recorded seizures were lower as compared to patients who did not exhibit seizures during the recording period. Sympathetic skin responses were greater and more prolonged in GTCS compared to FIAS. EDA recordings from wearable devices offer a noninvasive tool to continuously monitor sympathetic activity with potential applications for seizure detection, prediction, and potentially sudden unexpected death in epilepsy (SUDEP) risk estimation.

Patterns and Predictors of Professional Interpreter Use in the Pediatric Emergency Department.

BACKGROUND AND OBJECTIVES: Professional interpretation for patients with limited English proficiency remains underused. Understanding predictors of use is crucial for intervention. We sought to identify factors associated with professional interpreter use during pediatric emergency department (ED) visits. METHODS: We video recorded ED visits for a subset of participants (n = 50; 20% of the total sample) in a randomized trial of telephone versus video interpretation for Spanish-speaking limited English proficiency families. Medical communication events were coded for duration, health professional type, interpreter (none, ad hoc, or professional), and content. With communication event as the unit of analysis, associations between professional interpreter use and assigned interpreter modality, health professional type, and communication content were assessed with multivariate random-effects logistic regression, clustered on the patient. RESULTS: We analyzed 312 communication events from 50 ED visits (28 telephone arm, 22 video arm). Professional interpretation was used for 36% of communications overall, most often for detailed histories (89%) and least often for procedures (11%) and medication administrations (8%). Speaker type, communication content, and duration were all significantly associated with professional interpreter use. Assignment to video interpretation was associated with significantly increased use of professional interpretation for communication with providers (adjusted odds ratio 2.7; 95% confidence interval: 1.1-7.0). CONCLUSIONS: Professional interpreter use was inconsistent over the course of an ED visit, even for patients enrolled in an interpretation study. Assignment to video rather than telephone interpretation led to greater use of professional interpretation among physicians and nurse practitioners but not nurses and other staff.

A multiresolution mixture generative adversarial network for video super-resolution.

Generative adversarial networks (GANs) have been used to obtain super-resolution (SR) videos that have improved visual perception quality and more coherent details. However, the latest methods perform poorly in areas with dense textures. To better recover the areas with dense textures in video frames and improve the visual perception quality and coherence in videos, this paper proposes a multiresolution mixture generative adversarial network for video super-resolution (MRMVSR). We propose a multiresolution mixture network (MRMNet) as the generative network that can simultaneously generate multiresolution feature maps. In MRMNet, the high-resolution (HR) feature maps can continuously extract information from low-resolution (LR) feature maps to supplement information. In addition, we propose a residual fluctuation loss function for video super-resolution. The residual fluctuation loss function is used to reduce the overall residual fluctuation on SR and HR video frames to avoid a scenario where local differences are too large. Experimental results on the public benchmark dataset show that our method outperforms the state-of-the-art methods for the majority of the test sets.

Past, Present and Future of Home video-electroencephalographic telemetry: A review of the development of in-home video-electroencephalographic recordings.

Video-electroencephalographic (EEG) monitoring is an essential tool in epileptology, conventionally carried out in a hospital epilepsy monitoring unit. Due to high costs and long waiting times for hospital admission, coupled with technological advances, several centers have developed and implemented video-EEG monitoring in the patient's home (home video-EEG telemetry [HVET]). Here, we review the history and current status of three general approaches to HVET: (1) supervised HVET, which entails setting up video-EEG in the patient's home with daily visiting technologist support; (2) mobile HVET (also termed ambulatory video-EEG), which entails attaching electrodes in a health care facility, supplying the patient and carers with the hardware and instructions, and then asking the patient and carer to set up recording at home without technologist support; and (3) cloud-based HVET, which adds to either of the previous models continuous streaming of video-EEG from the home to the health care provider, with the option to review data in near real time, troubleshoot hardware remotely, and interact remotely with the patient. Our experience shows that HVET can be highly cost-effective and is well received by patients. We note limitations related to long-term electrode attachment and correct camera placing while the patient is unsupervised at home, and concerns related to regulations regarding data privacy for cloud services. We believe that HVET opens significant new opportunities for research, especially in the field of understanding the many influences in seizure occurrence. We speculate that in the future HVET may merge into innovative new multisensor approaches to continuously monitoring people with epilepsy.

Atypical duration of epileptic and psychogenic nonepileptic events.

OBJECTIVES: We aimed to estimate the frequency of epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES) with atypical duration in our epilepsy monitoring unit (EMU), in order to raise awareness of atypical durations of both types of events. MATERIALS & METHODS: We retrospectively reviewed all consecutive video-electroencephalogram (vEEG) recordings in our medical center's EMU from January 2013 to December 2017 and identified patients with seizures with atypical duration. Short PNES were defined as those lasting fewer than 2 min and long ES as those lasting for more than 5 min. RESULTS: The files of 830 adult (age >16 years) patients were reviewed, of whom 26 patients (3.1%, mean age: 33.3 ±â€¯9.8 years, 12 females) were diagnosed as having an unusual seizure duration. Among 432 patients with ES during monitoring, fourteen patients [3.2% (95% confidence interval (CI): 1.5%-5.0%), mean age: 33.0 ±â€¯12.2, 5 females [had long ES durations (exceeding 5 min). In 64% of patients with long ES, the events were provoked by antiepileptic drug (AED) withdrawal during vEEG, 62% had focal lesion on brain imaging, and 64% had a frontotemporal or a temporal seizure focus. Among 223 patients diagnosed with PNES, 12 patients [5.4% (95% CI: 2.2%-8.6%), mean age: 33.6 ±â€¯6.6, 7 females] had short PNES durations (less than 2 min) and demonstrated motor (9/12, 75%), altered responsiveness (6/12, 50%), and vocalization (5/12, 42%) as the most prominent clinical features. CONCLUSIONS: The data from our case files highlight two main considerations in the diagnosis of paroxysmal events: prolonged event can be due to ES, while short events can be psychogenic.

BET 2: Video laryngoscopy for patients requiring endotracheal intubation in the emergency department.

A short-cut review of the literature was carried out to examine whether video laryngoscopy (VL) could improve first-pass success and reduce complication rates in ED patients requiring endotracheal intubation, when compared with direct laryngoscopy. Four papers were identified as suitable for inclusion using the reported search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated. It is concluded that current evidence suggests VL is likely to improve first-pass success and reduce oesophageal intubation rates, but there is no evidence at present that it improves clinically relevant outcomes. In addition, no difference was found between first-pass success rates in senior/experienced operators, who should use techniques with which they are familiar.

Communication about suicide in YouTube videos: Content analysis of German-language videos retrieved with method-and help-related search terms.

Online searches for information on suicide are very common but studies on how the topic is addressed on one of the the most relevant platforms, YouTube, are missing. We performed a content analysis of German-language videos retrieved with the basic term "suicide", a method-related search term ("how to hang yourself"), and a help-related term ("suicide prevention"). We assessed the quality of n=232 randomly selected videos based on media recommendations for suicide reporting. Characteristics of videos retrieved with the method- and help-related search term, were compared to search results for "suicide". Videos retrieved with the help-related term had more potentially protective and fewer harmful characteristics than those retrieved with the other search terms. For example, these videos significantly more often debunked suicide myths and provided contact information to help services. In total, the mean number of harmful and protective characteristics per video were 1.6 and 1.3 for basic searches; 1.7 and 1.0 for method-related searches, and 0.4 and 2.8 for help-related searches, respectively. Videos retrieved in the help-related search were often from help organizations. Only 3% and 8% of videos retrieved with "suicide" and "how to hang yourself", respectively, were age-restricted. Collaborations between suicide prevention and Youtube are warranted to improve the visibility of protective contents and ensure a better implementation of Youtube's own policies regarding self-harm.

Photographic and Video Deepfakes Have Arrived: How Machine Learning May Influence Plastic Surgery.

Advances in computer science and photography not only are pervasive but are also quantifiably influencing the practice of medicine. Recent progress in both software and hardware technology has translated into the design of advanced artificial neural networks: computer frameworks that can be thought of as algorithms modeled on the human brain. In practice, these networks have computational functions, including the autonomous generation of novel images and videos, frequently referred to as "deepfakes." The technological advances that have resulted in deepfakes are readily applicable to facets of plastic surgery, posing both benefits and harms to patients, providers, and future research. As a specialty, plastic surgery should recognize these concepts, appropriately discuss them, and take steps to prevent nefarious uses. The aim of this article is to highlight these emerging technologies and discuss their potential relevance to plastic surgery.

The coexistence of psychogenic nonepileptic and epileptic seizures in the same patient is more frequent than expected: Is there any clinical feature for defining these patients?

OBJECTIVES: This study aimed to investigate the prevalence of psychogenic nonepileptic seizures (PNES) and PNES-epilepsy coexistence within all video-electroencephalography (EEG) monitoring unit (VEMU) referrals and to identify semiological and electrophysiological features to differentiate patients with PNES-epilepsy coexistence from PNES-only. METHODS: We retrospectively reviewed medical files, VEMU reports, and videos of 1983 adult patients. Demographical, historical, clinical, neuroimaging, and electrophysiological parameters of all patients were recorded. We classified patients into five groups as definite PNES-only, definite PNES-epilepsy coexistence, definite PNES-probable epilepsy coexistence, probable PNES-definite epilepsy coexistence, and probable PNES-only. We defined a "definite" group when we saw the ictal EEG and/or video recording of the seizure. The "probable" term is used when there is strong evidence from the history of a particular seizure type and suggestive interictal EEGs without video recordings. RESULTS: Two hundred and three of 1983 patients (10.23%) had PNES. Sixty-six of patients with PNES (32.51%) had definite PNES-epilepsy coexistence. When probable cases were included, the PNES-epilepsy coexistence ratio was 53.69% within all patients with PNES. The prevalence of PNES-epilepsy coexistence was 3.32% within all our VEMU referrals. Lower high school graduation rate, earlier age of disease onset, history of status epilepticus, febrile convulsion and brain surgery, use of three or more antiepileptic drugs, and abnormal magnetic resonance imaging (MRI) findings supported PNES-epilepsy coexistence (p < 0.05). On the contrary, seizure duration longer than 10 min was in favor of PNES-only (p < 0.05). CONCLUSIONS: The prevalence of PNES-epilepsy coexistence might be more frequent in VEMUs than expected. Some demographic and semiological features and electrophysiological findings might be useful in differentiating patients with PNES-epilepsy coexistence from patients with PNES-only.

Outcome of prolonged video-EEG monitoring in a new VA monitoring unit.

BACKGROUND AND OBJECTIVE: For patients with refractory seizures or seizure-like activity, prolonged inpatient video-electroencephalography (EEG) (v-EEG) is standard of care to guide diagnosis and management. The purpose of this study was to describe the outcome of v-EEG in a new Veterans' Administration (VA) hospital epilepsy monitoring unit (EMU). METHODS: We reviewed all prolonged (>24 h) inpatient v-EEGs performed in our EMU (2 beds) at the James A Haley VA in Tampa, FL over a five-and-a-half-year period (11/2013-07/2019). A total of 216 prolonged v-EEGs were performed. The patient population consisted of adult veterans (185 males, 31 females) ranging from 21 years to 89 years old (mean 52.5). The duration of monitoring ranged from 24 h to 9 days (mean 3.6 days). RESULTS: Of the 216 studies, 39 (18%) exclusively had epileptic seizures (ES). Of these, 37 (95%) had focal seizures, and 2 (5%) had generalized seizures. Of the 37 cases with focal seizures, all but 2 had clear ictal changes on EEG. Eighteen (8.5%) EEG studies revealed interictal epileptiform abnormalities without a clinical event. Sixty-eight (31.5%) of the v-EEGs had exclusively nonepileptic events (NEE). Of these, 27 (12.5%) were psychogenic nonepileptic seizures (PNES), and 41 (19%) were other NEE. Ninety-one (42%) of the studies were inconclusive, either because of lack of events captured (63) or because the events recorded were not the patient's typical episodes (27). SIGNIFICANCE: Compared to non-VA series, we found a lower proportion of PNES, and a higher proportion of inconclusive studies.

Video-EEG.

Indications for video-EEG monitoring (VEM) include differential diagnosis of paroxysmal events including epileptic seizures, organic nonepileptic seizures, and psychogenic nonepileptic seizures; classification of seizure types and electroclinical syndromes; quantification of seizures and of interictal and ictal epileptiform discharges; and presurgical evaluation in medically refractory epilepsy patients. Standardized questionnaires and examinations should be used on admission to the epilepsy monitoring unit (EMU). Patients should be provided with comprehensive information concerning purpose and procedures during VEM and need to sign informed consents. Staff working in the EMU needs to be properly trained in the management of seizures and periictal testing according to written protocols as well as in cardiopulmonary resuscitation. Minimum staffing ratios of dedicated healthcare professionals to patients have been recommended. Antiepileptic drug tapering/withdrawal needs to be individualized for each patient. EEG recordings have to be performed according to established guidelines. Cardiorespiratory monitoring including continuous ECG monitoring and continuous measurement of oxygen saturation is strongly recommended. Patient safety is of utmost importance during VEM. Indicators for reporting quality and safety have been developed. Standardized ictal testing protocols and standardized computer-based organized reporting should further improve standards of VEM and training of EMU staff, and facilitate data exchange and collaborations between EMUs.

Digital recording and documentation of endoscopic procedures: physicians' practice and perspectives.

BACKGROUND: In recent years, it has become increasingly prevalent internationally to record and archive digital recordings of endoscopic procedures. This emerging documentation tool raises weighty educational, ethical and legal issues - which are viewed as both deterrents and incentives to its adoption. We conducted a survey study aimed at evaluating the use of DRD in endoscopic procedures, to examine physicians' support of this practice and to map the considerations weighed by physicians when deciding whether or not to support a more extensive use of DRD. METHODS: Israeli physicians from specialties that employ endoscopic technics were surveyed anonymously for demographic background, existence and use of recording equipment, existence of institutional guidelines regarding DRD, and self-ranking (on a scale from 1 to 7) of personal attitudes regarding DRD. RESULTS: 322 physicians were surveyed. 84% reported performing routine endoscopic procedures, 78% had the required equipment for digital recording, and 64% of them stated that they never or only rarely actually recorded the procedure. General surgeons had the second highest rate of DRD equipment (96.5%) but the lowest rates of DRD practice (17.5%). The average ranking of support of DRD by all participants was 5.07 ± 1.9, indicating a moderately high level of support. Significant positive correlation exists between actual DRD rates and average support of DRD (p < 0.001). Based on mediation models, for all specialties and with no exceptions, having routine recording guidelines and positive support of DRD were found to increase the probability of actual recording. Being a surgeon or an urologist negatively correlated with support of DRD, and decreased actual recording rates. The argument "Recording might cause more lawsuits" was ranked significantly higher than all other arguments against DRD (p < 0.001), and "Recording could aid teaching of interns" was ranked higher than all other arguments in favor of DRD (p < 0.001). CONCLUSIONS: While DRD facilities and equipment are fairly widespread in Israel, the actual recording rate is generally low and varies among specialties. Having institutional guidelines requiring routine recording and a positive personal support of DRD correlated with actual DRD rates, with general surgeons being markedly less supportive of DRD and having the lowest actual recording rates. Physicians in all specialties were very much concerned about DRD's potential to enhance lawsuits, and this greatly influenced their use of DRD. These findings should be addressed by educational efforts, centering on professionals from reluctant specialties, as well as by the issuing of both professional and institutional guidelines endorsing DRD as well as requiring it where applicable.

Comparison of New Era's Education Platforms, YouTube® and WebSurg®, in Sleeve Gastrectomy.

INTRODUCTION: The Internet is a widely used resource for obtaining medical information. However, the quality of information on online platforms is still debated. Our goal in this quality-controlled WebSurg® and YouTube®-based study was to compare these two online video platforms in terms of the accuracy and quality of information about sleeve gastrectomy videos. METHODS: Most viewed (popular) videos returned by YouTube® search engine in response to the keyword "sleeve gastrectomy" were included in the study. The educational accuracy and quality of the videos were evaluated according to known scoring systems. A novel scoring system measured technical quality. The ten most viewed (popular) videos in WebSurg® in response to the keyword "sleeve gastrectomy" were compared with ten YouTube® videos with the highest educational/technical scores. RESULTS: Scoring systems measuring the educational accuracy and quality of WebSurg® videos were significantly higher than ten YouTube® videos which have the most top technical scores (p < 0.05), and no significant difference was found in the assessment of ten YouTube® videos that have the highest technical ratings compared with WebSurg® videos (p 0.481). CONCLUSIONS: WebSurg® videos, which were passed through a reviewing process and were mostly prepared by academicians, remained below the expected quality. The main limitation of WebSurg® and YouTube® is the lack of information on preoperative and postoperative processes.

Development of a Mobile Motion Capture (MO2CA) System for Future Military Application.

State-of-the-art three-dimensional motion analysis systems, which are utilized to predict, diagnose, and treat many musculoskeletal and neurological disorders, are expensive and space consuming. These systems have only been widely used in large research facilities because of their lack of this transportability. Since device portability is a critically important in the military, most small military hospitals are therefore deprived of these systems. The purpose of this study was to develop a mobile motion capture system, MO2CA, to automatically detect the movement of the human body. Twenty healthy young adults participated in this study. Colored tape was attached on the heel, and subjects walked on the treadmill at three different speeds: preferred, fast, and slow. Two motion capture systems were used concurrently: Qualisys (100 Hz) and MO2CA (60 Hz). Four dependent variables were: stride length, stride time, stride length variability, and stride time variability. Paired t-tests, Pearson correlation, and Bland-Altman plots were used to investigate the statistical differences between two systems. No significant differences were found for all dependent variables. Regression and Bland-Altman plots showed strong agreements between the two systems. Our MO2CA shows a potential for real-time tracking of biomechanical changes in gait, which is extremely important for military use.

Cameras on beds: The ethics of surveillance in nursing home rooms.

Surveillance cameras are increasingly being deployed in nursing homes and assisted living facilities, with insufficient attention to what is ethically fraught about this way of assuaging concerns about abuse and other personnel challenges. With seven state laws now regulating camera monitoring and more on the way, it is urgent for us to consider the ethical implications of how we use technology to keep older adults safe. Drawing on findings from the first facility survey on this topic, we address three ethical issues: the risk that in-room cameras pose to residents' privacy and dignity, the risk of undermining care workers' sense of being fiduciaries for residents, and the probable extension of camera use by facilities to monitor staff and residents. We argue that with an aging population, intensifying strain on the care workforce, and ease of access to Web-connected cameras, this is a critical moment to address these ethical challenges.