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Author(s):  
Andrea Moglia ◽  
Luca Morelli ◽  
Roberto D’Ischia ◽  
Lorenzo Maria Fatucchi ◽  
Valentina Pucci ◽  
...  

Abstract Background Artificial intelligence (AI) has the potential to enhance patient safety in surgery, and all its aspects, including education and training, will derive considerable benefit from AI. In the present study, deep-learning models were used to predict the rates of proficiency acquisition in robot-assisted surgery (RAS), thereby providing surgical programs directors information on the levels of the innate ability of trainees to facilitate the implementation of flexible personalized training. Methods 176 medical students, without prior experience with surgical simulators, were trained to reach proficiency in five tasks on a virtual simulator for RAS. Ensemble deep neural networks (DNN) models were developed and compared with other ensemble AI algorithms, i.e., random forests and gradient boosted regression trees (GBRT). Results DNN models achieved a higher accuracy than random forests and GBRT in predicting time to proficiency, 0.84 vs. 0.70 and 0.77, respectively (Peg board 2), 0.83 vs. 0.79 and 0.78 (Ring walk 2), 0.81 vs 0.81 and 0.80 (Match board 1), 0.79 vs. 0.75 and 0.71 (Ring and rail 2), and 0.87 vs. 0.86 and 0.84 (Thread the rings 2). Ensemble DNN models outperformed random forests and GBRT in predicting number of attempts to proficiency, with an accuracy of 0.87 vs. 0.86 and 0.83, respectively (Peg board 2), 0.89 vs. 0.88 and 0.89 (Ring walk 2), 0.91 vs. 0.89 and 0.89 (Match board 1), 0.89 vs. 0.87 and 0.83 (Ring and rail 2), and 0.96 vs. 0.94 and 0.94 (Thread the rings 2). Conclusions Ensemble DNN models can identify at an early stage the acquisition rates of surgical technical proficiency of trainees and identify those struggling to reach the required expected proficiency level.


2022 ◽  
pp. 1-22
Author(s):  
Majse Lind ◽  
Carla Sharp ◽  
William L. Dunlop

Researchers and clinicians are beginning to adopt dimensional approaches in the study and treatment of personality disorders (PD). Although dimensional approaches in the DSM-5 and ICD-11 hold considerable benefit, they need to better incorporate an appreciation of individuals’ life stories, or narrative identities. Doing so will be necessary to flesh out the emphasis that both frameworks place on the role of identity in personality pathology. In this article, the authors review why, how, and when narrative identity theory and research can be integrated within dimensional approaches to PD. The authors describe established ways to assess narrative identity, review extant research on this construct in relation to PD, and signal areas crucial for future research. Stories lie at the heart of what it means to be human. The authors conclude that a greater consideration of the ways in which the self is storied can help further understanding and treatment of PD.


2021 ◽  
Vol 19 (12) ◽  
pp. 1377-1381
Author(s):  
Steven M. Blum ◽  
William R. Jeck ◽  
Lindsay Kipnis ◽  
Ronald Bleday ◽  
Jonathan A. Nowak ◽  
...  

Two major molecular pathways of colorectal carcinogenesis, chromosomal instability (CIN) and microsatellite instability (MSI), are considered to be mutually exclusive. Distinguishing CIN from MSI-high tumors has considerable therapeutic implications, because patients with MSI-high tumors can derive considerable benefit from immune checkpoint inhibitors, and tumors that evolved through the CIN pathway do not respond to these agents. Familial adenomatous polyposis (FAP) is a genetic syndrome that is defined by a mutation in the APC gene and is thought to lead to carcinogenesis through the CIN pathway. Here, we report a case of a young woman with FAP who was treated for medulloblastoma as a child and developed advanced MSI-high colon cancer as a young adult. Her response to second-line immunotherapy enabled resection of her colon cancer, and she is free of disease >10 months after surgery. This case highlights the potential for overlap between the CIN and MSI carcinogenic pathways and associated therapeutic implications.


Genes ◽  
2021 ◽  
Vol 12 (11) ◽  
pp. 1816
Author(s):  
Bohdan Kousal ◽  
Lucia Hlavata ◽  
Hana Vlaskova ◽  
Lenka Dvorakova ◽  
Michaela Brichova ◽  
...  

The aim of this study was to identify RS1 pathogenic variants in Czech patients with X-linked retinoschisis (XLRS) and to describe the associated phenotypes, including natural history, in some cases. Twenty-one affected males from 17 families were included. The coding region of RS1 was directly sequenced and segregation of the identified mutations was performed in available family members. In total, 12 disease-causing variants within RS1 were identified; of these c.20del, c.275G>A, c.[375_379del; 386A>T], c.539C>A and c.575_576insT were novel, all predicted to be null alleles. The c.539C>A mutation occurred de novo. Three patients (aged 8, 11 and 19 years) were misdiagnosed as having intermediate uveitis and treated with systemic steroids. Repeat spectral domain optical coherence tomography examinations in four eyes documented the transition from cystoid macular lesions to macular atrophy in the fourth decade of life. Four individuals were treated with topical dorzolamide and in two of them, complete resolution of the cystic macular lesions bilaterally was achieved, while one patient was noncompliant. Rebound phenomenon after discontinuation of dorzolamide for 7 days was documented in one case. Misdiagnosis of XLRS for uveitis is not uncommon; therefore, identification of disease-causing variants is of considerable benefit to the affected individuals.


2021 ◽  
Vol 27 ◽  
Author(s):  
Faiza Idris Himasa ◽  
Manmohan Singhal ◽  
Abhijeet Ojha ◽  
Bhavna Kumar

: Diabetic retinopathy is posterior eye disorder in which a damage occurs to the light sensitive retina due to diabetes mellitus, and affects people aged 18 - 64 with type ІІ diabetes. This disease progresses through different pathophysiological pathways. This includes oxidative stress, inflammation, stimulation of the growth factor in the eye’s vasculature, isoforms of protein kinase C, and also the activation of the hexosamine pathway. It starts as micro aneurysms and advances in complicated stage which results in retinal detachment. Treatment of posterior eye diseases has complications which are due to the structural design of the eye and physiological barriers present. The current treatment approach involves use of intravitreal anti-VEGFs, corticosteroids implants, laser and surgery; these treatment methods have drawbacks attributed to them despite their benefits. Development of a robust delivery system with minimal or no invasion to tackle the issues of diabetic retinopathy will be of considerable benefit to patients having diabetic retinopathy; the dependency on ophthalmologists for multiple injections will significantly reduce and provide a promising approach in drug delivery. In this review article, the authors provided information related to existing treatment methods available for diabetic retinopathy, the most significant nanotechnology approach through which local delivery via the ocular route to posterior eye can be achieved. It also possesses the various carriers studied for the non-invasive approach for retinal delivery of medicaments. Non-invasive approach for delivery of drugs can be considered as potential for treatment of diabetic retinopathy.


2021 ◽  
Vol 12 ◽  
Author(s):  
Francesca Coppola ◽  
Lorenzo Faggioni ◽  
Michela Gabelloni ◽  
Fabrizio De Vietro ◽  
Vincenzo Mendola ◽  
...  

Artificial intelligence (AI) has seen dramatic growth over the past decade, evolving from a niche super specialty computer application into a powerful tool which has revolutionized many areas of our professional and daily lives, and the potential of which seems to be still largely untapped. The field of medicine and medical imaging, as one of its various specialties, has gained considerable benefit from AI, including improved diagnostic accuracy and the possibility of predicting individual patient outcomes and options of more personalized treatment. It should be noted that this process can actively support the ongoing development of advanced, highly specific treatment strategies (e.g., target therapies for cancer patients) while enabling faster workflow and more efficient use of healthcare resources. The potential advantages of AI over conventional methods have made it attractive for physicians and other healthcare stakeholders, raising much interest in both the research and the industry communities. However, the fast development of AI has unveiled its potential for disrupting the work of healthcare professionals, spawning concerns among radiologists that, in the future, AI may outperform them, thus damaging their reputations or putting their jobs at risk. Furthermore, this development has raised relevant psychological, ethical, and medico-legal issues which need to be addressed for AI to be considered fully capable of patient management. The aim of this review is to provide a brief, hopefully exhaustive, overview of the state of the art of AI systems regarding medical imaging, with a special focus on how AI and the entire healthcare environment should be prepared to accomplish the goal of a more advanced human-centered world.


2021 ◽  
pp. 219256822110357
Author(s):  
Rahul G. Samtani ◽  
Antonio Webb ◽  
John Burleson ◽  
Sigurd Berven ◽  
Alekos Theologis ◽  
...  

Study Design: Cross-sectional observational. Background: The use of social media by providers can enhance patient education, complement offline information, facilitate patient support, stimulate brand building, and strengthen the organization’s market position. Risks of social media include, but are not limited to, a lack of quality, reliability, misrepresentation of credentials, influence of hidden and overt conflicts of interest, content that may jeopardize patient privacy, HIPAA regulations, and physicians’ credentials and licensure. Physicians’ use of social media may also expose him/her to lawsuits if providing specific medical advice on media platforms. Objective: To document the social media presence of a broad cohort of spine surgeons, and to discuss the benefits and risks of a social media presence. Methods: Cross-sectional observational of 325 Spine Surgeons from 76 institutions across the US. Description statistic and Pearson’s correlation were used to investigate the relationships between the variables. Results: Out of the 325 surgeons, 96% were male with an average age of 51.5 ± 10.7 years and 14.1 ± 9.6 years of experience. The frequency of social media use included 57.2% of surgeons had professional LinkedIn, 17.8% had professional Facebook, and less than 16% had other social media platforms. When combining all platforms together, 64.6% of all surgeons had at least one professional social media platform. 64.0% of these surgeons had no social media activity in the past 90 days, while 19.4% and 10.9% were active once and twice a month, respectively. Surgeon age ( P = 0.004), years in practice ( P < 0.001), and practice type ( P < 0.001) were strongly correlated with social media activity. Conclusions: Given the scarcity of research on this topic and the novelty of the platforms, social media and online services continue to be utilized at a low level by spine surgeons. Issues regarding the risks of privacy issues with social media users continue to be a concern among medical professionals adopting this technology. This can largely be mitigated with the combination of physician education and informed consent from patients. The ability to connect with patients directly, and provide access to high-quality education and information will be of considerable benefit to our field well into the future.


2021 ◽  
pp. 33-74
Author(s):  
Marina Lvovna Vartanova

The chapter "National Priorities and Prospects for the Development of the Eurasian Economic Integration" is devoted to such issues as modern integration processes and prospects for the socio-economic development of the countries of the Eurasian Economic Union. The author describes the trends, problems, and contradictions of integration processes, and substantiates proposals for improving the effectiveness of building a new integration association in the post-Soviet space. A very positive impression on the reader is made by the thoroughness, the fundamental nature of the work under consideration, and the author's coverage of numerous aspects of the complex and acutely topical problem of the current state of the Eurasian Economic Union. This chapter will also be of undoubted and considerable benefit to all those who are interested in the problems of the formation of the Eurasian Economic Union.


Cancers ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1669
Author(s):  
Sarah Powell-Brett ◽  
Rupaly Pande ◽  
Keith J. Roberts

Improving outcomes among patients with resectable pancreatic cancer is one of the greatest challenges of modern medicine. Major improvements in survival will result from the development of novel therapies. However, optimising existing pathways, so that patients realise benefits of already proven treatments, presents a clear opportunity to improve outcomes in the short term. This narrative review will focus on treatments and interventions where there is a clear evidence base to improve outcomes in pancreatic cancer, and where there is also evidence of variation and under-treatment. Avoidance of preoperative biliary drainage, treatment of pancreatic exocrine insufficiency, prehabiliation and enhanced recovery after surgery, reducing perioperative complications, optimising opportunities for elderly patients to receive therapy, optimising adjuvant chemotherapy and regular surveillance after surgery are some of the strategies discussed. Each treatment or pathway change represents an opportunity for marginal gain. Accumulation of marginal gains can result in considerable benefit to patients. Given that these interventions already have evidence base, they can be realised quickly and economically.


2021 ◽  
pp. 001041402199716
Author(s):  
Lutz Gschwind

Record-high levels of international migration both toward and across Europe have recently given rise to a new body of research on the social protection of immigrants. A recurring argument in this literature maintains that migrants are generally more likely to gain access to social benefits in generous welfare states. The article offers a critical review of this hypothesis with a focus on unemployment benefit provision. The tides of European welfare politics have produced a set of systems in the past which are today highly stratified on the basis of employment. This mechanism generates a considerable benefit gap in reference to migration, especially for those who arrived to their country of residency only recently. Empirical analyses with micro-level data for 14 Western European countries provide supporting evidence for this argument. The findings indicate a negative relationship between generosity and social protection which has not been accounted for in previous research.


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