Diagnostic validation of vertebral heart score machine learning algorithm for canine lateral chest radiographs

OBJECTIVES

The vertebral heart score is a measurement used to index heart size relative to thoracic vertebra. Vertebral heart score can be a useful tool for identifying and staging heart disease and providing prognostic information. The purpose of this study is to validate the use of a vertebral heart score algorithm compared to manual vertebral heart scoring by three board-certified veterinary cardiologists.

MATERIALS AND METHODS

A convolutional neural network centred around semantic segmentation of relevant anatomical features was developed to predict heart size and vertebral bodies. These predictions were used to calculate the vertebral heart score. An external validation study consisting of 1200 canine lateral radiographs was randomly selected to match the underlying distribution of vertebral heart scores. Three American College of Veterinary Internal Medicine board-certified cardiologists were enrolled to manually score 400 images each using the traditional Buchanan method. Post-scoring, the cardiologists evaluated the algorithm for misaligned anatomic landmarks and overall image quality.

RESULTS

The 95th percentile absolute difference between the cardiologist vertebral heart score and the algorithm vertebral heart score was 1.05 vertebrae (95% confidence interval: 0.97 to 1.20 vertebrae) with a mean bias of -0.09 vertebrae (95% confidence interval: -0.12 to -0.05 vertebrae). In addition, the model was observed to be well calibrated across the predictive range.

CLINICAL SIGNIFICANCE

We have found the performance of the vertebral heart score algorithm comparable to three board-certified cardiologists. While validation of this vertebral heart score algorithm has shown strong performance compared to veterinarians, further external validation in other clinical settings is warranted before use in those settings.

697 The Use of Augmented and Mixed Reality Technology to Improve Surgical Outcomes: A Systematic Review

Aim

The use of augmented and mixed reality technology is a novel and rapidly developing field. This technology has generated significant interest in surgery, however the evidence supporting its proposed benefits is limited. This systematic review aims to critically appraise the intraoperative use of augmented and mixed reality technology to improve surgical outcomes in order to provide directions for future research.

Method

This systematic review is registered with PROSPERO (CRD42020205892) and was performed in adherence to PRISMA guidelines. Studies reporting primary data on surgical outcomes of the intraoperative use of augmented and mixed reality technology were included. A structured search of major literature databases was performed. Risk of bias was assessed following the guidance of the Cochrane Handbook.

Results

68 studies met the inclusion criteria, with 63 reporting the intraoperative use of augmented reality technology and 5 reporting the use of mixed reality. The number and methodological quality of these studies is increasing. The intraoperative use of this technology has been demonstrated to reduce operative times, intraoperative blood loss and lengths of hospital admissions in specific settings. The widespread adoption of this technology faces the challenges of its cost, technical precision and integration into the surgical workflow.

Conclusions

The intraoperative use of augmented and mixed reality technology is an area of research still in its early stages, with an increasing number of methodologically robust studies on the subject. Current results suggest that the use of this technology is safe and, in certain applications, has the potential to significantly improve surgical and health-economic outcomes.

'Ball valve' small bowel obstruction caused by a large caecal faecolith

Small bowel obstruction is a common surgical presentation, but intestinal faecoliths are rarely reported as a cause. A 75-year-old woman presented with small bowel obstruction from a large faecolith lodged in the caecum. This required removal at laparoscopy-assisted surgery. This case highlights the need to deal promptly with symptomatic intestinal faecoliths as they are unlikely to pass spontaneously and are prone to cause acute obstruction.

Order of microbial succession affects rhizobia-mediated biocontrol efforts against Phytophthora root rot

The management of soilborne root diseases in pulse crops is challenged by a limited range of resistance sources and often a complete absence of in-crop management options. Therefore, alternative management strategies need to be developed. We evaluated disease limiting interactions between the rhizobia species Mesorhizobium ciceri, and the oomycete pathogen Phytophthora medicaginis, which causes Phytophthora root rot (PRR) of chickpea (Cicer arietinum). For the PRR susceptible var. Sonali plants, post-pathogen M. ciceri inoculation significantly improved probability of plant survival when compared to P. medicaginis infected plants only pre-inoculated with M. ciceri (75 % versus 35 %, respectively). Potential mechanisms for these effects were investigated: rhizobia inoculation benefits to plant nodulation were not demonstrated, but the highest nodule N-fixation activity of P. medicaginis inoculated plants occurred for the post-pathogen M. ciceri treatment; rhizobia inoculation treatment did not reduce lesion development but certain combinations of microbial inoculation led to significant reduction in root growth. Microcosm studies, however, showed that the presence of M. ciceri reduced growth of P. medicaginis isolates. Putative chickpea disease resistance gene expression was evaluated using qPCR in var. Sonali roots. When var. Sonali plants were treated with M. ciceri post-P. medicaginis inoculation, the gene regulation in the plant host became more similar to PRR moderately resistant var. PBA HatTrick. These results suggest that M. ciceri application post P. medicaginis inoculation may improve plant survival by inducing defense responses similar to a PRR moderately resistant chickpea variety. Altogether, these results indicate that order of microbial succession can significantly affect PRR plant survial in susceptible chickpea under controlled conditions and improved plant survival effects are due to a number of different mechanisms including improved host nutrition, through direct inhibiton of pathogen growth, as well as host defense priming.

Rapid Semimicro Method for the Determination of Methyl Mercury in Fish Tissue

A fast semimicro method for the determination of methyl mercury in fish tissue is described. The procedure involves extracting the methyl mercury into toluene as methyl mercuric bromide, partitioning the bromide into aqueous ethanol as a thiosulfate complex, and re-extracting into benzene as methyl mercuric iodide. Methyl mercury is quantitated with gas chromatography. The method is sensitive to 0.01 ppm. Recoveries of added methyl mercury were 99% and the presence of methyl mercury in the final extract was shown by thin layer chromatography and gas chromatography of the thin layer spot. A variety of mercurial compounds do not interfere in the analyses. The amounts of both methyl and total mercury found in a variety of tissues of aquatic animals are compared. The presence of a demethylase in seal is suggested by the findings of high levels of nonmethyl mercury. Additional cleanup by column chromatography on Florisil was necessary with certain samples. The gas chromatographic columns were kept operational by the intermittent injection of 3M potassium iodide. Due to column bleed and resulting detector contamination, the use of the easily cleaned concentric tube electron capture detector is recommended.

Talking to Dogs: Companion Animal-Directed Speech in a Stress Test

Companion animal-directed speech (CADS) has previously been investigated in comparison to infant-directed speech and adult-directed speech. To investigate the influence of owner caregiving, attachment pattern, and personality on CADS, we used the Ainsworth strange situation procedure. It allowed us to assess voice source parameters of CADS across different contexts. We extracted speech parameters (voicing duration, voice pitch, pitch range, and jitter) from 53 dog owners recorded during the procedure. We found that owner personality and gender but not caregiving/attachment behavior affect their voice's pitch, range, and jitter during CADS. Further, we found a differential and context-specific modification of pitch and range, consistent with the idea that pitch communicates affect, whereas range is more of an attention-getting device. This differential usage, and the increased pitch, emphasize and support the parallels described between CADS and infant-directed speech. For the first time, we also show the effect of personality on CADS and lay the basis for including jitter as a potentially useful measure in CADS.

Attachment security in companion dogs: adaptation of Ainsworth's strange situation and classification procedures to dogs and their human caregivers

This exploratory study describes the development of a classification system for dogs’ attachment security to caregivers that adheres closely to Ainsworth’s seminal methodology. Fifty-nine adult dogs and caregivers participated in a mildly threatening laboratory encounter with a stranger (TS) and the Strange Situation (SSP). Dog and attachment experts adapted Ainsworth’s classification system  for the behavioral repertoire of the dog. Four potentially comparable patterns of attachment were identified. The proportions of secure and insecure classifications (61% and 39%) were similar to those found in human toddlers. Caregivers’ sensitivity to their dogs during the TS procedure significantly differentiated dogs with secure vs. insecure classifications Lower scores on the Active/excited personality scale on the Monash Canine Personality Questionnaire-Revised (MCPQ-R) also were related to secure classification. This system now makes it possible to compare directly the effects of human and dog attachment patterns on the health and emotional well-being of humans and dogs.

Shifting Boundaries in Professional Care

The nature of the work undertaken by different health professionals and inter-professional boundaries are constantly shifting. The greater knowledge of users of health care, and the increasing technical and organizational complexity of modern medicine, have partly eroded the control of health professionals over the substance of their work. The definition of a field of work as lying within the province of any one profession is culturally rather than scientifically determined.

It is evident that care of good quality should be delivered at the lowest possible cost. This might include delivery of care by a less trained person than heretofore, or by someone with limited but focused training. Sharing of skills is a more sensible subject for discussion than transfer of tasks. We review a number of studies which show the effectiveness of inter-professional substitution in various care settings, and also the effectiveness of substitution by those other than health professionals. The views of users of health services on inter-professional substitution need to be considered. Health professionals and others need to work together to devise innovative ways of delivering effective health care. The legal issues need clarification.

Disorganized attachment in infancy: a review of the phenomenon and its implications for clinicians and policy-makers

Disorganized/Disoriented (D) attachment has seen widespread interest from policy makers, practitioners, and clinicians in recent years. However, some of this interest seems to have been based on some false assumptions that (1) attachment measures can be used as definitive assessments of the individual in forensic/child protection settings and that disorganized attachment (2) reliably indicates child maltreatment, (3) is a strong predictor of pathology, and (4) represents a fixed or static "trait" of the child, impervious to development or help. This paper summarizes the evidence showing that these four assumptions are false and misleading. The paper reviews what is known about disorganized infant attachment and clarifies the implications of the classification for clinical and welfare practice with children. In particular, the difference between disorganized attachment and attachment disorder is examined, and a strong case is made for the value of attachment theory for supportive work with families and for the development and evaluation of evidence-based caregiving interventions.

Toward an architecture of attachment disorganization: John Bowlby's published and unpublished reflections

This article examines the construct of disorganized attachment originally proposed by Main and Solomon, developing some new conjectures based on inspiration from a largely unknown source: John Bowlby's unpublished texts, housed at the Wellcome Trust Library Archive in London (with permission from the Bowlby family). We explore Bowlby's discussions of disorganized attachment, which he understood from the perspective of ethological theories of conflict behavior. Bowlby's reflections regarding differences among the behaviors used to code disorganized attachment will be used to explore distinctions that may underlie the structure of the current coding system. The article closes with an emphasis on the importance Bowlby placed on Popper's distinction between the context of discovery and the context of justification in developmental science.

Infant disorganized attachment: Clarifying levels of analysis

Lack of clarity regarding the infant disorganized attachment classification has caused confusion in the clinical, forensic, and research contexts in which it is used. This article offers distinctions to clarify the concept with the goal of increasing understanding and identifying potential misapplications. In particular, attention is drawn to the fact that there are many indices used to code “disorganized attachment,” and that so far they have been validated as a set rather than individually; and it is noted that the construct validation of disorganization in naturalistic settings is partially finished. Clinicians and social workers should be cautious in their interpretations of such behavior.

The Attachment Doll Play Assessment: Predictive Validity with Concurrent Mother-Child Interaction and Maternal Caregiving Representations

Attachment is central to the development of children’s regulatory processes. It has been associated with developmental and psychiatric health across the life span, especially emotional and behavioral regulation of negative affect when stressed (Schore, 2001; Schore and Schore, 2008). Assessment of attachment patterns provides a critical frame for understanding emerging developmental competencies and formulating treatment and intervention. Play-based attachment assessments provide access to representational models of attachment, which are regarded in attachment theory as the central organizing mechanisms associated with stability or change (Bowlby, 1969/1982; Bretherton and Munholland, 2008). The Attachment Doll Play Assessment (ADPA, George and Solomon, 1990–2016; Solomon et al., 1995) is a prominent established representational attachment measure for children aged early latency through childhood. This study examines the predictive validity of the ADPA to caregiving accessibility and responsiveness assessed from mother-child interaction and maternal representation. Sixty nine mothers and their 5–7-year-old children participated in this study. Mother-child interaction was observed during a pre-separation dyadic interaction task. Caregiving representations were rated from the Caregiving Interview (George and Solomon, 1988/1993/2005/2007). Child security with mother was associated with positive dyadic interaction and flexibly integrated maternal caregiving representations. Child controlling/disorganized attachments were significantly associated with problematic dyadic interaction and dysregulated-helpless maternal caregiving representations. The clinical implications and the use of the ADPA in clinical and educational settings are discussed.

Wait Up!: Attachment and Sovereign Power

Sociologists and feminist scholars have, over many decades, characterised attachment as a social construction that functions to support political and gender conservatism. We accept that attachment theory has seen use to these ends and consider recent deployments of attachment theory as justification for a minimal State within conservative political discourse in the UK since 2009. However, we contest that attachment is reducible to its discursive construction. We consider Judith Butler's depiction of the infant attached to an abusive caregiver as a foundation and parallel to the position of the adult citizen subjected to punitive cultural norms and political institutions. We develop and qualify Butler's account, drawing on the insights offered by the work of Lauren Berlant. We also return to Foucault's Psychiatric Power lectures, in which familial relations are situated as an island of sovereign power within the sea of modern disciplinary institutions. These reflections help advance analysis of three important issues: the social and political implications of attachment research; the relationship between disciplinary and sovereign power in the affective dynamic of subjection; and the political and ethical status of professional activity within the psy disciplines.

A multinational study of colonization with extended spectrum β-lactamase-producing Enterobacteriaceae in healthcare personnel and family members of carrier patients hospitalized in rehabilitation centres

The study aims were: (i) to define the prevalence of and risk factors for colonization by extended spectrum β-lactamase (ESBL) -producing Enterobacteriaceae (EPE) among healthcare workers (HCWs) and family members (FMs) of EPE-colonized patients in rehabilitation units and (ii) to compare EPE isolates from these three groups. The study included 286 FMs of 194 EPE-carrying patients identified in five rehabilitation units located in Israel, Italy, France and Spain. The EPE were detected in rectal swabs from 26 (9%) of 286 FMs screened. In multivariate analyses, older age of FM, greater mean number of hours spent with the patient, being a daughter or a female spouse of a patient, and chronic lung disease of the patient were significantly associated with carriage in the FM. Escherichia coli was the most common organism (76%), followed by Klebsiella pneumoniae (19%). Isolates were typed by pulsed field gel electrophoresis and multilocus sequence typing, and ESBLs were identified by PCR sequencing. A comparison of paired species isolates from FMs and their respective patient showed that 17 of 23 strains were indistinguishable. EPE were detected in 35 (3.5%, E. coli = 34) of the 1001 HCWs screened. Feeding patients was associated with EPE carriage by HCWs. Only 7 of 23 E. coli subclones cultured from HCWs were also represented among 376 patient-derived ESBL-producing E. coli isolates from the same rehabilitation units. In Spain, a higher proportion of HCWs and FMs were ESBL carriers than elsewhere (p <0.05). In conclusion, the molecular and epidemiological data suggest that FMs are at higher risk of EPE acquisition from their relative patients than HCWs.