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1. Deep brain stimulation: At your own risk

   https://doi.org/10.1109/ISTAS52410.2021.9629205  

   Remmers, Lauryn ; Michael, Katina ( October 2021 , 2021 IEEE International Symposium on Technology and Society (ISTAS))

   Deep Brain Stimulation (DBS) surgeries are not new, although they were only granted approval in the U.S. by the U.S. Food and Drug Administration (FDA) in 2002 for advanced Parkinson’s Disease (PD). In 2016, DBS surgery was approved for earlier stages of PD. This does not mean that DBS surgery, generally considered minimally invasive, does not come without commensurate risks. The Mayo Clinic identifies DBS as a serious and potential risky procedure, whereby those eligible must carefully weigh pros and cons. The aim of this paper is to provide a general overview of deep brain stimulation surgery and to present the findings of available informational resources on 14 hospital and medical center web sites that were reviewed, pertaining to surgical procedures and policies: pre-operative to post-operative. The article focuses on critiquing available educational DBS materials and their adequacy in addressing potential risks of DBS surgery. The findings indicate that hospital informational resources on the DBS surgical technique reaffirm each other’s educational materials and that they positively inform patient decision-making. These factors can be linked to better post-operative recovery. However, the materials provided by the hospitals overemphasize the positive aspects of DBS with relatively little detail about potential side effects. Thismore »article also outlines the potential short-term and long-term side effects of DBS surgery as identified by the DBS educational literature found on the hospital web sites reviewed.« less
2. Prescriptive Analytics for Reducing 30-day Hospital Readmissions after General Surgery

   Bertsimas, Dimitris ; Lingzhi, Michael Li ; Paschalidis, Ioannis Ch. ; Wang, Taiyao ( September 2020 , PloS one)

   Introduction: New financial incentives, such as reduced Medicare reimbursements, have led hospitals to closely monitor their readmission rates and initiate efforts aimed at reducing them. In this context, many surgical departments participate in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), which collects detailed demographic, laboratory, clinical, procedure and perioperative occurrence data. The availability of such data enables the development of data science methods which predict readmissions and, as done in this paper, offer specific recommendations aimed at preventing readmissions. Materials and Methods: This study leverages NSQIP data for 722,101 surgeries to develop predictive and prescriptive models, predicting readmissions and offering real-time, personalized treatment recommendations for surgical patients during their hospital stay, aimed at reducing the risk of a 30-day readmission. We applied a variety of classification methods to predict 30-day readmissions and developed two prescriptive methods to recommend pre-operative blood transfusions to increase the patient’s hematocrit with the objective of preventing readmissions. The effect of these interventions was evaluated using several predictive models. Results: Predictions of 30-day readmissions based on the entire collection of NSQIP variables achieve an out-of-sample accuracy of 87% (Area Under the Curve—AUC). Predictions based only on pre-operative variables have an accuracy ofmore »74% AUC, out-of-sample. Personalized interventions, in the form of pre-operative blood transfusions identified by the prescriptive methods, reduce readmissions by 12%, on average, for patients considered as candidates for pre-operative transfusion (pre-operative hematoctic <30). The prediction accuracy of the proposed models exceeds results in the literature. Conclusions: This study is among the first to develop a methodology for making specific, data-driven, personalized treatment recommendations to reduce the 30-day readmission rate. The reported predicted reduction in readmissions can lead to more than $20 million in savings in the U.S. annually.« less
3. Pain and Laboratory Animals: Publication Practices for Better Data Reproducibility and Better Animal Welfare

   https://doi.org/10.1371/journal. pone.0155001  

   Larry Carbone, Jamie Austin ( May 2016 , PloS one)

   Scientists who perform major survival surgery on laboratory animals face a dual welfare and methodological challenge: how to choose surgical anesthetics and post-operative analgesics that will best control animal suffering, knowing that both pain and the drugs that manage pain can all affect research outcomes. Scientists who publish full descriptions of animal procedures allow critical and systematic reviews of data, demonstrate their adherence to animal welfare norms, and guide other scientists on how to conduct their own studies in the field. We investigated what information on animal pain management a reasonably diligent scientist might find in planning for a successful experiment. To explore how scientists in a range of fields describe their management of this ethical and methodological concern, we scored 400 scientific articles that included major animal survival surgeries as part of their experimental methods, for the completeness of information on anesthesia and analgesia. The 400 articles (250 accepted for publication pre-2011, and 150 in 2014–15, along with 174 articles they reference) included thoracotomies, craniotomies, gonadectomies, organ transplants, peripheral nerve injuries, spinal laminectomies and orthopedic procedures in dogs, primates, swine, mice, rats and other rodents. We scored articles for Publication Completeness (PC), which was any mention of use ofmore »anesthetics or analgesics; Analgesia Use (AU) which was any use of post-surgical analgesics, and Analgesia Completeness (a composite score comprising intra-operative analgesia, extended post-surgical analgesia, and use of multimodal analgesia). 338 of 400 articles were PC. 98 of these 338 were AU, with some mention of analgesia, while 240 of 338 mentioned anesthesia only but not postsurgical analgesia. Journals’ caliber, as measured by their 2013 Impact Factor, had no effect on PC or AU. We found no effect of whether a journal instructs authors to consult the ARRIVE publishing guidelines published in 2010 on PC or AC for the 150 mouse and rat articles in our 2014–15 dataset. None of the 302 articles that were silent about analgesic use included an explicit statement that analgesics were withheld, or a discussion of how pain management or untreated pain might affect results. We conclude that current scientific literature cannot be trusted to present full detail on use of animal anesthetics and analgesics. We report that publication guidelines focus more on other potential sources of bias in experimental results, under-appreciate the potential for pain and pain drugs to skew data, PLOS ONE | DOI:10.1371/journal.pone.0155001 May 12, 2016 1 / 24 a11111 OPEN ACCESS Citation: Carbone L, Austin J (2016) Pain and Laboratory Animals: Publication Practices for Better Data Reproducibility and Better Animal Welfare. PLoS ONE 11(5): e0155001. doi:10.1371/journal. pone.0155001 Editor: Chang-Qing Gao, Central South University, CHINA Received: December 29, 2015 Accepted: April 22, 2016 Published: May 12, 2016 Copyright: © 2016 Carbone, Austin. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Authors may be contacted for further information. Funding: This study was funded by the United States National Science Foundation Division of Social and Economic Sciences. Award #1455838. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. and thus mostly treat pain management as solely an animal welfare concern, in the jurisdiction of animal care and use committees. At the same time, animal welfare regulations do not include guidance on publishing animal data, even though publication is an integral part of the cycle of research and can affect the welfare of animals in studies building on published work, leaving it to journals and authors to voluntarily decide what details of animal use to publish. We suggest that journals, scientists and animal welfare regulators should revise current guidelines and regulations, on treatment of pain and on transparent reporting of treatment of pain, to improve this dual welfare and data-quality deficiency.« less
4. Robotic Replica of a Human Spine Uses Soft Magnetic Sensor Array to Forecast Intervertebral Loads and Posture after Surgery

   https://doi.org/10.3390/s22010212  

   Lin, Maohua ; Abd, Moaed A. ; Taing, Alex ; Tsai, Chi-Tay ; Vrionis, Frank D. ; Engeberg, Erik D. ( January 2022 , Sensors)

   Cervical disc implants are conventional surgical treatments for patients with degenerative disc disease, such as cervical myelopathy and radiculopathy. However, the surgeon still must determine the candidacy of cervical disc implants mainly from the findings of diagnostic imaging studies, which can sometimes lead to complications and implant failure. To help address these problems, a new approach was developed to enable surgeons to preview the post-operative effects of an artificial disc implant in a patient-specific fashion prior to surgery. To that end, a robotic replica of a person’s spine was 3D printed, modified to include an artificial disc implant, and outfitted with a soft magnetic sensor array. The aims of this study are threefold: first, to evaluate the potential of a soft magnetic sensor array to detect the location and amplitude of applied loads; second, to use the soft magnetic sensor array in a 3D printed human spine replica to distinguish between five different robotically actuated postures; and third, to compare the efficacy of four different machine learning algorithms to classify the loads, amplitudes, and postures obtained from the first and second aims. Benchtop experiments showed that the soft magnetic sensor array was capable of precisely detecting the location and amplitudemore »of forces, which were successfully classified by four different machine learning algorithms that were compared for their capabilities: Support Vector Machine (SVM), K-Nearest Neighbor (KNN), Random Forest (RF), and Artificial Neural Network (ANN). In particular, the RF and ANN algorithms were able to classify locations of loads applied 3.25 mm apart with 98.39% ± 1.50% and 98.05% ± 1.56% accuracies, respectively. Furthermore, the ANN had an accuracy of 94.46% ± 2.84% to classify the location that a 10 g load was applied. The artificial disc-implanted spine replica was subjected to flexion and extension by a robotic arm. Five different postures of the spine were successfully classified with 100% ± 0.0% accuracy with the ANN using the soft magnetic sensor array. All results indicated that the magnetic sensor array has promising potential to generate data prior to invasive surgeries that could be utilized to preoperatively assess the suitability of a particular intervention for specific patients and to potentially assist the postoperative care of people with cervical disc implants.« less
5. "AI in healthcare: data governance challenges"

   https://doi.org/10.21037/jhmhp-2020-ai-05  

   Winter, J.S. ( March 2021 , Journal of hospital management and health policy)

   Reddy, S. ; Winter, J.S. ; Padmanabhan, S. (Ed.)

   AI applications are poised to transform health care, revolutionizing benefits for individuals, communities, and health-care systems. As the articles in this special issue aptly illustrate, AI innovations in healthcare are maturing from early success in medical imaging and robotic process automation, promising a broad range of new applications. This is evidenced by the rapid deployment of AI to address critical challenges related to the COVID-19 pandemic, including disease diagnosis and monitoring, drug discovery, and vaccine development. At the heart of these innovations is the health data required for deep learning applications. Rapid accumulation of data, along with improved data quality, data sharing, and standardization, enable development of deep learning algorithms in many healthcare applications. One of the great challenges for healthcare AI is effective governance of these data—ensuring thoughtful aggregation and appropriate access to fuel innovation and improve patient outcomes and healthcare system efficiency while protecting the privacy and security of data subjects. Yet the literature on data governance has rarely looked beyond important pragmatic issues related to privacy and security. Less consideration has been given to unexpected or undesirable outcomes of healthcare in AI, such as clinician deskilling, algorithmic bias, the “regulatory vacuum”, and lack of public engagement. Amidstmore »growing calls for ethical governance of algorithms, Reddy et al. developed a governance model for AI in healthcare delivery, focusing on principles of fairness, accountability, and transparency (FAT), and trustworthiness, and calling for wider discussion. Winter and Davidson emphasize the need to identify underlying values of healthcare data and use, noting the many competing interests and goals for use of health data—such as healthcare system efficiency and reform, patient and community health, intellectual property development, and monetization. Beyond the important considerations of privacy and security, governance must consider who will benefit from healthcare AI, and who will not. Whose values drive health AI innovation and use? How can we ensure that innovations are not limited to the wealthiest individuals or nations? As large technology companies begin to partner with health care systems, and as personally generated health data (PGHD) (e.g., fitness trackers, continuous glucose monitors, health information searches on the Internet) proliferate, who has oversight of these complex technical systems, which are essentially a black box? To tackle these complex and important issues, it is important to acknowledge that we have entered a new technical, organizational, and policy environment due to linked data, big data analytics, and AI. Data governance is no longer the responsibility of a single organization. Rather, multiple networked entities play a role and responsibilities may be blurred. This also raises many concerns related to data localization and jurisdiction—who is responsible for data governance? In this emerging environment, data may no longer be effectively governed through traditional policy models or instruments.« less