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The writer's room : the hidden worlds that shape the books we love
What is it that so fascinates us about the spaces where writers work? Why does a remote cabin, ramshackle shed or library garret, strewn with papers and piled with books, so capture our imagination? The rooms of certain writers are mythologised almost as much as the works themselves: the Brontë's study in the parsonage; Virginia Woolf's garden room at Monks House; Sigmund Freud's study, with its famous couch. Blending cultural critique with the personal and historical, 'The Writer's Room' takes us on a fascinating journey through the hidden worlds that shape the books we love.
BOOK
Comparison of Paravertebral Block by Anatomic Landmark Technique to Ultrasound-Guided Paravertebral Block for Breast Surgery Anesthesia: A Randomized Controlled Trial
BACKGROUND AND OBJECTIVESParavertebral block (PVB) is an established technique for providing anesthesia for breast surgery. The primary objective was to compare anatomical landmark technique (ALT) to the ultrasound-guided (USG) PVB block for providing surgical anesthesia. Secondary objectives included comparison of perioperative analgesia and complications.
METHODSThis randomized, controlled, observer-blinded study included 72 females, aged 18 to 65 years, American Society of Anesthesiologists physical status I or II, undergoing elective unilateral breast surgery. Study participants were randomized to the ALT group or USG group. Ipsilateral PVB was performed with the respective technique from T1 to T6. Five milliliters of local anesthetic mixture (0.5% ropivacaine, 5 μg/mL adrenaline, 1 μg/kg clonidine) was administered at each level. Paravertebral catheter was inserted at T4/T3 level. After confirming sensory loss, patients were taken up for surgery with propofol sedation (20–50 μg/kg per minute).
RESULTSMore patients in the USG group (34/36 [94.44%]) had a successful block as compared with the ALT group (26/36 [72.22%]) (P = 0.024). Difference in proportion was 18.1 (95% confidence interval, 0.15–36.0) (P = 0.024) after adjustment for age. More dermatomes were blocked in the USG group (P = 0.0018) with less sparing of upper T2 and T3 dermatomes (P = 0.003, P = 0.006, respectively). Median time to first postoperative analgesic requirement was 502.5 minutes (range, 195–1440 minutes) in the USG group versus 377.5 minutes (range, 215–1440 minutes) in the ALT group. Pain at rest and movement 2 and 4 hours postoperatively and number of catheter top-ups in 24 hours postoperatively were lesser in the USG group (P = 0.012). Complications were comparable.
CONCLUSIONSUltrasound-guided PVB provided better anesthesia and perioperative analgesia than the landmark technique for breast surgery.
CLINICAL TRIAL REGISTRATIONThe trial was registered retrospectively at the Clinical Trial Registry of India, CTRI/2015/05/005774.
Journal Article
Erector Spinae Plane Block Versus Retrolaminar Block: A Magnetic Resonance Imaging and Anatomical Study
Background and ObjectivesThe erector spinae plane (ESP) and retrolaminar blocks are ultrasound-guided techniques for thoracoabdominal wall analgesia involving injection into the musculofascial plane between the paraspinal back muscles and underlying thoracic vertebrae. The ESP block targets the tips of the transverse processes, whereas the retrolaminar block targets the laminae. We investigated if there were differences in injectate spread between the 2 techniques that would have implications for their clinical effect.MethodsThe blocks were performed in 3 fresh cadavers. The ESP and retrolaminar blocks were performed on opposite sides of each cadaver at the T5 vertebral level. Twenty milliliters of a radiocontrast dye mixture was injected in each block, and injectate spread was assessed by magnetic resonance imaging and anatomical dissection.ResultsBoth blocks exhibited spread to the epidural and neural foraminal spaces over 2 to 5 levels. The ESP block produced additional spread to intercostal spaces over 5 to 9 levels and was associated with a greater extent of craniocaudal spread along the paraspinal muscles.ConclusionsThe clinical effect of ESP and retrolaminar blocks can be explained by epidural and neural foraminal spread of local anesthetic. The ESP block produces additional intercostal spread, which may contribute to more extensive analgesia. The implications of these cadaveric observations require confirmation in clinical studies.
Journal Article
Facial Landmark Detection: A Literature Survey
The locations of the fiducial facial landmark points around facial components and facial contour capture the rigid and non-rigid facial deformations due to head movements and facial expressions. They are hence important for various facial analysis tasks. Many facial landmark detection algorithms have been developed to automatically detect those key points over the years, and in this paper, we perform an extensive review of them. We classify the facial landmark detection algorithms into three major categories: holistic methods, Constrained Local Model (CLM) methods, and the regression-based methods. They differ in the ways to utilize the facial appearance and shape information. The holistic methods explicitly build models to represent the global facial appearance and shape information. The CLMs explicitly leverage the global shape model but build the local appearance models. The regression based methods implicitly capture facial shape and appearance information. For algorithms within each category, we discuss their underlying theories as well as their differences. We also compare their performances on both controlled and in the wild benchmark datasets, under varying facial expressions, head poses, and occlusion. Based on the evaluations, we point out their respective strengths and weaknesses. There is also a separate section to review the latest deep learning based algorithms. The survey also includes a listing of the benchmark databases and existing software. Finally, we identify future research directions, including combining methods in different categories to leverage their respective strengths to solve landmark detection “in-the-wild”.
Journal Article
LANDMARKS FOR THE HEALTHY INCLUSION OF THE SICK CHILD: THE INCLUSION OF CHILDREN WITH SEVERE CHRONIC DISEASES IN THE EDUCATION SYSTEM
The purpose of this study was to examine the process that teachers undergo in coping with the placement of a chronically ill child in their classes and the factors that affect this process from the teachers' point of view. The research population consisted of twenty homeroom teachers that were the teachers of the sick child for at least a year from the onset of the disease or for one consecutive school year. Data were analyzed by means of qualitative analytical induction, in which data are organized according to primary categories, and these categories are corrected, improved and processed as the study progresses. The research findings revealed an authentic body of knowledge that teachers structured. The findings provide comprehensive information about the characteristics of the sick child from the point of view of the teachers. The findings present behavior profiles of the teachers, related to the child's various ecological environments, which advance or delay effective inclusion, as the teachers see it.
Journal Article
Development of an artificial intelligence system using deep learning to indicate anatomical landmarks during laparoscopic cholecystectomy
BackgroundThe occurrence of bile duct injury (BDI) during laparoscopic cholecystectomy (LC) is an important medical issue. Expert surgeons prevent intraoperative BDI by identifying four landmarks. The present study aimed to develop a system that outlines these landmarks on endoscopic images in real time.MethodsAn intraoperative landmark indication system was constructed using YOLOv3, which is an algorithm for object detection based on deep learning. The training datasets comprised approximately 2000 endoscopic images of the region of Calot's triangle in the gallbladder neck obtained from 76 videos of LC. The YOLOv3 learning model with the training datasets was applied to 23 videos of LC that were not used in training, to evaluate the estimation accuracy of the system to identify four landmarks: the cystic duct, common bile duct, lower edge of the left medial liver segment, and Rouviere’s sulcus. Additionally, we constructed a prototype and used it in a verification experiment in an operation for a patient with cholelithiasis.ResultsThe YOLOv3 learning model was quantitatively and subjectively evaluated in this study. The average precision values for each landmark were as follows: common bile duct: 0.320, cystic duct: 0.074, lower edge of the left medial liver segment: 0.314, and Rouviere’s sulcus: 0.101. The two expert surgeons involved in the annotation confirmed consensus regarding valid indications for each landmark in 22 of the 23 LC videos. In the verification experiment, the use of the intraoperative landmark indication system made the surgical team more aware of the landmarks.ConclusionsIntraoperative landmark indication successfully identified four landmarks during LC, which may help to reduce the incidence of BDI, and thus, increase the safety of LC. The novel system proposed in the present study may prevent BDI during LC in clinical practice.
Journal Article