scholarly journals The Clinical Value of Explainable Deep Learning for Diagnosing Fungal Keratitis Using in vivo Confocal Microscopy Images

2021 ◽  
Vol 8 ◽  
Author(s):  
Fan Xu ◽  
Li Jiang ◽  
Wenjing He ◽  
Guangyi Huang ◽  
Yiyi Hong ◽  
...  
Keyword(s):  
Confocal Microscopy ◽  
Controlled Trial ◽  
Fungal Keratitis ◽  
Great Promise ◽  
Clinical Value ◽  
Randomized Controlled ◽  
Prediction Probability ◽  
Microscopy Images ◽  
Activation Mapping

Background: Artificial intelligence (AI) has great potential to detect fungal keratitis using in vivo confocal microscopy images, but its clinical value remains unclarified. A major limitation of its clinical utility is the lack of explainability and interpretability.Methods: An explainable AI (XAI) system based on Gradient-weighted Class Activation Mapping (Grad-CAM) and Guided Grad-CAM was established. In this randomized controlled trial, nine ophthalmologists (three expert ophthalmologists, three competent ophthalmologists, and three novice ophthalmologists) read images in each of the conditions: unassisted, AI-assisted, or XAI-assisted. In unassisted condition, only the original IVCM images were shown to the readers. AI assistance comprised a histogram of model prediction probability. For XAI assistance, explanatory maps were additionally shown. The accuracy, sensitivity, and specificity were calculated against an adjudicated reference standard. Moreover, the time spent was measured.Results: Both forms of algorithmic assistance increased the accuracy and sensitivity of competent and novice ophthalmologists significantly without reducing specificity. The improvement was more pronounced in XAI-assisted condition than that in AI-assisted condition. Time spent with XAI assistance was not significantly different from that without assistance.Conclusion: AI has shown great promise in improving the accuracy of ophthalmologists. The inexperienced readers are more likely to benefit from the XAI system. With better interpretability and explainability, XAI-assistance can boost ophthalmologist performance beyond what is achievable by the reader alone or with black-box AI assistance.

A randomized controlled trial comparing autologous radiolabeled in vivo platelet (PLT) recoveries and survivals of 7-day-stored PLT-rich plasma and buffy coat PLTs from the same subjects

Transfusion ◽  
2011 ◽  
Vol 51 (6) ◽  
pp. 1241-1248 ◽  
Author(s):  
Larry J. Dumont ◽  
Deborah F. Dumont ◽  
Zoe M. Unger ◽  
Alan Siegel ◽  
Zbigniew M. Szczepiorkowski ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Buffy Coat ◽  
Randomized Controlled

scholarly journals 11β-Hydroxysteroid dehydrogenase type 1 inhibition in idiopathic intracranial hypertension: a double-blind randomized controlled trial

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Keira Markey ◽  
James Mitchell ◽  
Hannah Botfield ◽  
Ryan S Ottridge ◽  
Tim Matthews ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Lumbar Puncture ◽  
Idiopathic Intracranial Hypertension ◽  
Controlled Trial ◽  
Hydroxysteroid Dehydrogenase ◽  
Opening Pressure ◽  
Double Blind ◽  
Randomized Controlled

Abstract Treatment options for idiopathic intracranial hypertension are limited. The enzyme 11β-hydroxysteroid dehydrogenase type 1 has been implicated in regulating cerebrospinal fluid secretion, and its activity is associated with alterations in intracranial pressure in idiopathic intracranial hypertension. We assessed therapeutic efficacy, safety and tolerability and investigated indicators of in vivo efficacy of the 11β-hydroxysteroid dehydrogenase type 1 inhibitor AZD4017 compared with placebo in idiopathic intracranial hypertension. A multicenter, UK, 16-week phase II randomized, double-blind, placebo-controlled trial of 12-week treatment with AZD4017 or placebo was conducted. Women aged 18–55 years with active idiopathic intracranial hypertension (>25 cmH2O lumbar puncture opening pressure and active papilledema) were included. Participants received 400 mg of oral AZD4017 twice daily compared with matching placebo over 12 weeks. The outcome measures were initial efficacy, safety and tolerability. The primary clinical outcome was lumbar puncture opening pressure at 12 weeks analysed by intention-to-treat. Secondary clinical outcomes were symptoms, visual function, papilledema, headache and anthropometric measures. In vivo efficacy was evaluated in the central nervous system and systemically. A total of 31 subjects [mean age 31.2 (SD = 6.9) years and body mass index 39.2 (SD = 12.6) kg/m2] were randomized to AZD4017 (n = 17) or placebo (n = 14). At 12 weeks, lumbar puncture pressure was lower in the AZD4017 group (29.7 cmH2O) compared with placebo (31.3 cmH2O), but the difference between groups was not statistically significant (mean difference: −2.8, 95% confidence interval: −7.1 to 1.5; P = 0.2). An exploratory analysis assessing mean change in lumbar puncture pressure within each group found a significant decrease in the AZD4017 group [mean change: −4.3 cmH2O (SD = 5.7); P = 0.009] but not in the placebo group [mean change: −0.3 cmH2O (SD = 5.9); P = 0.8]. AZD4017 was safe, with no withdrawals related to adverse effects. Nine transient drug-related adverse events were reported. One serious adverse event occurred in the placebo group (deterioration requiring shunt surgery). In vivo biomarkers of 11β-hydroxysteroid dehydrogenase type 1 activity (urinary glucocorticoid metabolites, hepatic prednisolone generation, serum and cerebrospinal fluid cortisol:cortisone ratios) demonstrated significant enzyme inhibition with the reduction in serum cortisol:cortisone ratio correlating significantly with reduction in lumbar puncture pressure (P = 0.005, R = 0.70). This is the first phase II randomized controlled trial in idiopathic intracranial hypertension evaluating a novel therapeutic target. AZD4017 was safe and well tolerated and inhibited 11β-hydroxysteroid dehydrogenase type 1 activity in vivo. Reduction in serum cortisol:cortisone correlated with decreased intracranial pressure. Possible clinical benefits were noted in this small cohort. A longer, larger study would now be of interest.

scholarly journals Cellular morphological changes detected by laser scanning in vivo confocal microscopy associated with clinical outcome in fungal keratitis

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Jaya D. Chidambaram ◽  
Namperumalsamy V. Prajna ◽  
Srikanthi Palepu ◽  
Shruti Lanjewar ◽  
Manisha Shah ◽  
...  
Keyword(s):  
Confocal Microscopy ◽  
Clinical Outcome ◽  
Laser Scanning ◽  
Morphological Changes ◽  
Fungal Keratitis ◽  
In Vivo Confocal Microscopy

Short-Term Training in Mindfulness Predicts Helping Behavior Toward Racial Ingroup and Outgroup Members

2021 ◽  
pp. 194855062110530
Author(s):  
Daniel R. Berry ◽  
Catherine S. J. Wall ◽  
Justin D. Tubbs ◽  
Fadel Zeidan ◽  
Kirk Warren Brown
Keyword(s):  
Controlled Trial ◽  
Helping Behavior ◽  
Mindfulness Training ◽  
Trait Mindfulness ◽  
Short Term ◽  
Randomized Controlled ◽  
Ecological Momentary ◽  
First Time ◽  
Momentary Assessment

A randomized controlled trial tested whether mindfulness training would increase lab-based and in vivo spontaneous helping behaviors toward racial outgroup members. First, across conditions, those scoring higher in baseline trait mindfulness showed higher levels of preintervention lab-based and ecological momentary assessment (EMA)-based helping behavior. Next, short-term (4-day) training in mindfulness, relative to a well-matched sham meditation training, increased interracial helping behavior in a lab-based simulation. Finally, among people scoring lower in a basic form of trait mindfulness at baseline—that is, with greater room for improvement—mindfulness training predicted higher postintervention in vivo helping behavior reported via EMA. However, neither training condition alone attenuated preferential helping toward racial ingroup members. These findings indicate, for the first time, that mindfulness and its training fosters helping behavior toward strangers and acquaintances regardless of their racial ingroup or outgroup status, but preferential helping of racial ingroup members remains.

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