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Drawing on the concept of resilient healthcare, this book explores multimodally embedded everyday practices of healthcare professionals in the UK and Japan, utilising novel technology, such as eye-tracking glasses, to inform what constitutes good practice.Providing an interdisciplinary examination of the theories and rationales of resilient.

IntroductionHealthcare team performance directly impacts the quality and safety of medical care. However, measuring the performance of teams is challenging and requires methodologies to investigate different contributing elements. This study proposes an AI(artificial intelligence)-driven multimodal approach to visualising gaze (ie, joint visual attention) and speech in medical team performance and examines how these might differ across medical expertise, using eye-trackers and our own automatic gaze annotation programme.MethodFour simulation sessions, two in Japan and another two in the UK, were filmed with eye-trackers worn by a clinician and a nurse. In each site, one session was conducted with an experienced pair (UK_Ex and JP_Ex) and the other with a less experienced pair (UK_LessEx and JP_LessEx). The scenarios were a difficult intubation in Japan and a urine infection, with a family member present, in the UK. The numbers of occurrences and the time lengths of joint attention and individuals’ speeches in the four data sets were compared in total and in 15 s time ranges to see the correlations.ResultThe Ex pairs in both contexts paid joint visual attention more frequently and longer and spoke more than the LessEx pairs. In the JP_Ex, the positive correlation was found between the numbers of joint attention and the total speech durations (r=0.81). That indicates the team members verbally coordinated each other’s attentional objects, which is termed coregulative attentional engagement. In contrast, in the UK_Ex, the correlation was negative (r=−0.70), where they visually monitored each other’s actions while talking to the patient’s family, which we call coinfluential attentional engagement. These tendencies were weak in the LessEx pairs.ConclusionAlthough the accuracy of automatic annotation (approximately. 40%–60%) should be improved before applying it to medical training, the research method could provide preliminary insight into elements of good team performance.

ObjectivesWe aimed to evaluate the effect of projection mapping (PM) on the quality and safety of central venous catheter (CVC) insertion under real-time ultrasound guidance.DesignProspective, observational, simulation study.SettingThis study was conducted at the Yokohama City University Medical Center (Yokohama, Japan). Volunteer residents were enrolled over 12 months from January to December 2023.Participants and methods12 rotating residents (postgraduation year (PGY) 1 and 2) and eight anaesthesia residents (PGY 3–5) placed the CVC in the internal jugular vein in a simulator under the real-time ultrasound guidance using the short-axis out-of-plane approach. The ultrasound image was provided either just caudad to the puncture site using the PM method or on the monitor of the ultrasound machine (conventional method) placed next to the simulator’s right shoulder. Each resident performed four punctures alternating between the PM and conventional methods, and the first method for each resident was chosen randomly. Eye-tracking analysis was also used to evaluate differences in gaze behaviour.Primary and secondary outcome measuresThe primary outcome was the procedure time defined as the time from the application of the ultrasound probe on the puncture field until successful puncture of the vein. The secondary outcomes were incidence of complications and eye-tracking analysis data.ResultsThe time to complete the line placement was significantly shorter for the PM than for the conventional method (median (IQR) 22.5 (15.5–30.6) s vs 30.0 (20.4–95.4) s; p=0.02, Wilcoxon’s signed-rank test). The incidence of posterior vessel wall puncture was significantly lower in the PM method (0% vs 25%; p=0.02, McNemar’s test). Eye-tracking analysis revealed that the percentage of time spent gazing at the ultrasound image was higher in the PM than in the conventional method (61.6% (55.0–69.2) vs 45.7% (34.1–54.5); p<0.01).ConclusionsThe PM method facilitates ultrasound-guided CVC placement while preventing excessive needle advancement in the inexperienced operators. This was accompanied by enhanced fixation of the participants’ line-of-sight on the ultrasound image.

How do people listen in a conversation, especially in an intercultural setting, and how do they shift from listener to speaker in the particular context? This book investigates listenership behaviours of a tutor and a student in the context of academic supervision sessions at a university in the UK, comparing British tutor - British student conversations with British tutor - Japanese student conversations in English. A new research methodology, a time-aligned multimodal corpus analysis, is introduced for analysing listenership and turn-taking structure, synthesising visual data with verbal data in timeline. The method also integrates discourse-pragmatic and conversation analytic approaches with the corpus-based analysis. This work reports strategies in use of response tokens for framework shifts and multi-functional nature of hand gestures observed in the conversations. Therefore, this book is highly relevant for researchers and postgraduate students, who study pragmatic and discursive practice in intercultural settings using multimodal corpora.

Image quality assessments (IQA) are an important task for providing appropriate medical care. Full-reference IQA (FR-IQA) methods, such as peak signal-to-noise ratio (PSNR) and structural similarity (SSIM), are often used to evaluate imaging conditions, reconstruction conditions, and image processing algorithms, including noise reduction and super-resolution technology. However, these IQA methods may be inapplicable for medical images because they were designed for natural images. Therefore, this study aimed to investigate the correlation between objective assessment by some FR-IQA methods and human subjective assessment for computed tomography (CT) images. For evaluation, 210 distorted images were created from six original images using two types of degradation: noise and blur. We employed nine widely used FR-IQA methods for natural images: PSNR, SSIM, feature similarity (FSIM), information fidelity criterion (IFC), visual information fidelity (VIF), noise quality measure (NQM), visual signal-to-noise ratio (VSNR), multi-scale SSIM (MSSSIM), and information content-weighted SSIM (IWSSIM). Six observers performed subjective assessments using the double stimulus continuous quality scale (DSCQS) method. The performance of IQA methods was quantified using Pearson’s linear correlation coefficient (PLCC), Spearman rank order correlation coefficient (SROCC), and root-mean-square error (RMSE). Nine FR-IQA methods developed for natural images were all strongly correlated with the subjective assessment (PLCC and SROCC > 0.8), indicating that these methods can apply to CT images. Particularly, VIF had the best values for all three items, PLCC, SROCC, and RMSE. These results suggest that VIF provides the most accurate alternative measure to subjective assessments for CT images.

Gadofosveset trisodium is available as a prolonged pooling vascular contrast agent for magnetic resonance imaging. As gadolinium (Gd)-based agents may increase the risk for nephrogenic systemic fibrosis in patients with severe renal insufficiency, the present study synthesized carboxymethyl-diethylaminoethyl dextran magnetite (CMEADM) particles as a blood-pooling, non-Gd-based contrast agent. CMEADM particles carry a negative or positive charge due to the binding of amino and carboxyl groups to the hydroxyl group of dextran. The present study evaluated whether the degree of charge alters the blood-pooling time. The evaluation was performed by injecting four groups of three Japanese white rabbits each with CMEADM−, CMEADM2−, CMEADM+ (surface charges: −10.4, −41.0 and +9.6 mV, respectively) or with ultrasmall superparamagnetic iron oxide (USPIO; −11.5 mV). The relative signal intensity (SIrel) of each was calculated using the following formula: SIrel = (SI post-contrast - SI pre-contrast / SI pre-contrast) × 100. Following injection with the CMEADMs, but not with USPIO, the in vivo pooling time was prolonged to >300 min. No significant differences were attributable to the electric charge among the CMEADM−, CMEADM2− or and CMEADM+ particles when analyzed with analysis of variance and Tukey's HSD test. Taken together, all three differently-charged CMEADM2 particles exhibited prolonged vascular enhancing effects, compared with the USPIO. The degree of charge of the contrast agents used in the present study did not result in alteration of the prolonged blood pooling time.

ObjectivesTo evaluate the diagnostic utility of electric properties tomography (EPT) in differentiating benign from malignant breast lesions in comparison with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).MethodsIn this institutional review board-approved retrospective study, 116 consecutive patients with 141 breast lesions (50 benign and 91 malignant) underwent 3-T MRI, including 3D turbo-spin echo (TSE) sequence and standard DCE-MRI scans between January 2014 and January 2017. The lesions were segmented semi-automatically using subtraction DCE-MR images, and they were registered to the phase images from 3D TSE. The mean conductivity of the lesion was obtained from phase-based reconstruction of lesions. From the DCE-MRI, initial enhancement rate (IER) and signal enhancement ratio (SER) were calculated from signal intensity (SI) as follows: IER = (SIearly - SIpre)/SIpre, SER = (SIearly - SIpre)/(SIdelayed - SIpre). The parameters from EPT and the DCE-MRI were compared between benign and malignant lesions.ResultsThere was significant difference in mean conductivity (0.14 ± 1.77 vs 1.14 ± 1.36 S/m, p < 0.0001) and SER (0.77 ± 0.28 vs 1.04 ± 0.25, p < 0.0001) between benign and malignant lesions, but not in IER (p = 0.06). Receiver operating curve (ROC) analysis revealed that the area under the curve (AUC) of the mean conductivity and SER was 0.71 and 0.80, respectively, without significant difference (p = 0.15).ConclusionsThe mean conductivity of EPT was significantly different between benign and malignant breast lesions as well as kinetic parameter or SER from DCE-MRI.Key Points• The conductivity of malignant lesions was higher than that of benign lesions.• EPT helps differentiatie benign from malignant lesions.• Diagnostic ability of EPT was not significantly different from that of DCE-MRI.

Purpose To evaluate the embolic effect and degradability of gelatin microspheres (GMS) using various degrees of cross-linkage and particle sizes in rabbit renal artery embolization. Methods Four types of GMS were used, as follows: 2 types of cross-linkage and 2 types of particle size. Twenty-four rabbits (6 in each group) were used for the renal artery embolization. Renal angiography was performed before and after embolization of right renal artery. Follow-up renal angiography was performed 2 days ( n  = 2), 5 days ( n  = 2), and 15 days ( n  = 2) after embolization in each group, and then kidneys were removed for histopathological evaluation. Vascular areas of the angiography were measured by Image J software, and the reperfusion rate was calculated. In renal specimens, residual GMS were checked and the degree of degradation was classified according to a 4-point scale. Results The mean amounts of large- and small-particle-size GMS injected were 15.0 and 34.3 mg, respectively. Tissue necrosis was confirmed in each group; however, no difference was observed among groups. Renal reperfusion was observed more with small GMS than with large GMS. Renal reperfusion was also observed more with low cross-linked GMS than with high cross-linked GMS. In histopathological specimens, large GMS were confirmed in lobar artery, and small GMS were confirmed in lobular artery. Low cross-linked GMS completely degraded 15 days after embolization. In contrast, high cross-linked GMS were persistent 15 days after embolization. Conclusion Degree of cross-linkage and particle size affected degradability and reperfusion.

Objective To evaluate the antitumor effects of miriplatin-lipidol suspension and emulsion. Materials and methods Fifty rabbits with VX2 liver tumors were randomly assigned to ten groups. Then, we prepared four types of mixtures: a suspension of lipiodol and miriplatin (ML), an emulsion of miriplatin dissolved with lipiodol and contrast medium (MLC) or saline (MLS), and saline alone (S). Ratios between lipiodol and contrast medium/saline volumes were 1:1/4, 1:1/2, 1:1, and 1:2 respectively. We used the same dose of miriplatin (2 mg/kg) and lipiodol (0.1 ml/kg) in each emulsion and suspension group. After intra-arterial infusion, the tumor growth rate was calculated, and sequential change of the plasma platinum concentration, the platinum concentration in the tumor and in surrounding normal liver tissue was also measured. Results Among the ten groups, the tumor growth rate was lower in MLC and MLS groups, and the difference between tumor treated with MLS emulsion (ratio 1:1/2) and ML suspension was significant ( p  = 0.02). The platinum concentration in the normal liver tissue was lower in MLS and MLC groups than in the ML group, and that in the tumor was higher in the MLS and MLC emulsion (ratio 1:1/2) groups. Conclusion We suggest that miriplatin-lipiodol emulsion may be more effective than suspension.

Magnetic resonance imaging (MRI) can detect atherosclerotic lesions containing accumulations of ultrasmall superparamagnetic iron oxides (USPIO). Positing that improved USPIO with a higher affinity for atherosclerotic plaques would yield better plaque images, we performed MRI and histologic studies to compare the uptake of dextran- and mannan-dextran-coated USPIO (D-USPIO and DM-USPIO, respectively) by the atherosclerotic walls of rabbits. We intravenously injected atherosclerotic rabbits with DM-USPIO (n = 5) or D-USPIO (n = 5). Two rabbits were the controls. The doses delivered were 0.08 (dose 1) (n = 1), 0.4 (dose 2) (n = 1), or 0.8 (dose 3) (n = 3) mmol iron/Kg. The dose 3 rabbits underwent in vivo contrast-enhanced magnetic resonance angiography (MRA) before and 5 days after USPIO administration. Afterwards, all animals were euthanized, the aortae were removed and subjected to in vitro MRI study. The signal-to-noise ratio (SNR) of the aortic wall in the same region of interest (ROI) was calculated in both in vivo and in vitro studies. Histological assessment through measurement of iron-positive regions in Prussian blue-stained specimens showed that iron-positive regions were significantly larger in rabbits injected with DM- rather than D-USPIO (P < 0.05) for all doses. In vivo MRA showed that the SNR-reducing effect of DM- was greater than that of D-USPIO (P < 0.05). With in vitro MRI scans, SNR was significantly lower in rabbits treated with dose 2 of DM-USPIO compared with D-USPIO treatment (P < 0.05), and it tended to be lower at dose 3 (P < 0.1). In conclusion, we suggest that DM-USPIO is superior to D-USPIO for the study of atherosclerotic lesions in rabbits.