The theory complements our earlier work, which developed extensions to cable theory for the micro-scale equations of neural stimulation that apply to individual fibres. The modelling framework provides a number of advantages over other approaches currently adopted in the literature and, therefore, can be used to accurately estimate the membrane potential generated by extracellular electrical stimulation.
Neuroprosthetic devices, such as cochlear and retinal implants, work by directly stimulating neurons with extracellular electrodes. This is commonly modeled using the cable equation with an applied extracellular voltage. In this paper a framework for modeling extracellular electrical stimulation is presented. To this end, a cylindrical neurite with confined extracellular space in the subthreshold regime is modeled in three-dimensional space. Through cylindrical harmonic expansion of Laplace's equation, we derive the spatio-temporal equations governing different modes of stimulation, referred to as longitudinal and transverse modes, under types of boundary conditions. The longitudinal mode is described by the well-known cable equation, however, the transverse modes are described by a novel ordinary differential equation. For the longitudinal mode, we find that different electrotonic length constants apply under the two different boundary conditions. Equations connecting current density to voltage boundary conditions are derived that are used to calculate the trans-impedance of the neurite-plus-thin-extracellular-sheath. A detailed explanation on depolarization mechanisms and the dominant current pathway under different modes of stimulation is provided. The analytic results derived here enable the estimation of a neurite's membrane potential under extracellular stimulation, hence bypassing the heavy computational cost of using numerical methods.
Objective
To demonstrate the potential of machine learning and capability of natural language processing (NLP) to predict disposition of patients based on triage notes in the ED.
Methods
A retrospective cohort of ED triage notes from St Vincent's Hospital (Melbourne) was used to develop a deep‐learning algorithm that predicts patient disposition. Bidirectional Encoder Representations from Transformers, a recent language representation model developed by Google, was utilised for NLP. Eighty percent of the dataset was used for training the model and 20% was used to test the algorithm performance. Ktrain library, a wrapper for TensorFlow Keras, was employed to develop the model.
Results
The accuracy of the algorithm was 83% and the area under the curve was 0.88. Sensitivity, specificity, precision and F1‐score of the algorithm were 72%, 86%, 56% and 63%, respectively.
Conclusion
Machine learning and NLP can be together applied to the ED triage note to predict patient disposition with a high level of accuracy. The algorithm can potentially assist ED clinicians in early identification of patients requiring admission by mitigating the cognitive load, thus optimises resource allocation in EDs.
The unique features of the composite model and its simplified versions can be used to accurately estimate the spatio-temporal response of neural tissue to extracellular electrical stimulation.
Currently, a challenge in electrical stimulation of the retina with a visual prosthesis (bionic eye) is to excite only the cells lying directly under the electrode in the ganglion cell layer, while avoiding excitation of axon bundles that pass over the surface of the retina in the nerve fiber layer. Stimulation of overlying axons results in irregular visual percepts, limiting perceptual efficacy. This research explores how differences in fiber orientation between the nerve fiber layer and ganglion cell layer leads to differences in the electrical activation of the axon initial segment and axons of passage. Approach. Axons of passage of retinal ganglion cells in the nerve fiber layer are characterized by a narrow distribution of fiber orientations, causing highly anisotropic spread of applied current. In contrast, proximal axons in the ganglion cell layer have a wider distribution of orientations. A four-layer computational model of epiretinal extracellular stimulation that captures the effect of neurite orientation in anisotropic tissue has been developed using a volume conductor model known as the cellular composite model. Simulations are conducted to investigate the interaction of neural tissue orientation, stimulating electrode configuration, and stimulation pulse duration and amplitude. Main results. Our model shows that simultaneous stimulation with multiple electrodes aligned with the nerve fiber layer can be used to achieve selective activation of axon initial segments rather than passing fibers. This result can be achieved while reducing required stimulus charge density and with only modest increases in the spread of activation in the ganglion cell layer, and is shown to extend to the general case of arbitrary electrode array positioning and arbitrary target volume. Significance. These results elucidate a strategy for more targeted stimulation of retinal ganglion cells with experimentally-relevant multi-electrode geometries and achievable stimulation requirements.
The validity of approximate equations describing the membrane potential under extracellular electrical stimulation (Meffin et al 2012 J. Neural Eng. 9 065005) is investigated through finite element analysis in this paper. To this end, the finite element method is used to simulate a cylindrical neurite under extracellular stimulation. Laplace's equations with appropriate boundary conditions are solved numerically in three dimensions and the results are compared to the approximate analytic solutions. Simulation results are in agreement with the approximate analytic expressions for longitudinal and transverse modes of stimulation. The range of validity of the equations describing the membrane potential for different values of stimulation and neurite parameters are presented as well. The results indicate that the analytic approach can be used to model extracellular electrical stimulation for realistic physiological parameters with a high level of accuracy.
Artificial intelligence is a rapidly evolving field, with modern technological advances and the growth of electronic health data opening new possibilities in diagnostic radiology. In recent years, the performance of deep learning (DL) algorithms on various medical image tasks have continually improved. DL algorithms have been proposed as a tool to detect various forms of intracranial hemorrhage on non-contrast computed tomography (NCCT) of the head. In subtle, acute cases, the capacity for DL algorithm image interpretation support might improve the diagnostic yield of CT for detection of this time-critical condition, potentially expediting treatment where appropriate and improving patient outcomes. However, there are multiple challenges to DL algorithm implementation, such as the relative scarcity of labeled datasets, the difficulties in developing algorithms capable of volumetric medical image analysis, and the complex practicalities of deployment into clinical practice. This review examines the literature and the approaches taken in the development of DL algorithms for the detection of intracranial hemorrhage on NCCT head studies. Considerations in crafting such algorithms will be discussed, as well as challenges which must be overcome to ensure effective, dependable implementations as automated tools in a clinical setting.
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