Machine Learning is the study of methods for programming computers to learn. Computers are applied to a wide range of tasks, and for most of these it is relatively easy for programmers to design and implement the necessary software. However, there are many tasks for which this is difficult or impossible. These can be divided into four general categories. First, there are problems for which there exist no human experts. For example, in modern automated manufacturing facilities, there is a need to predict machine failures before they occur by analyzing sensor readings. Because the machines are new, there are no human experts who can be interviewed by a programmer to provide the knowledge necessary to build a computer system. A machine learning system can study recorded data and subsequent machine failures and learn prediction rules. Second, there are problems where human experts exist, but where they are unable to explain their expertise. This is the case in many perceptual tasks, such as speech recognition, hand-writing recognition, and natural language understanding. Virtually all humans exhibit expert-level abilities on these tasks, but none of them can describe the detailed steps that they follow as they perform them. Fortunately, humans can provide machines with examples of the inputs and correct outputs for these tasks, so machine learning algorithms can learn to map the inputs to the outputs. Third, there are problems where phenomena are changing rapidly. In finance, for example, people would like to predict the future behavior of the stock market, of consumer purchases, or of exchange rates. These behaviors change frequently, so that even if a programmer could construct a good predictive computer program, it would need to be rewritten frequently. A learning program can relieve the programmer of this burden by constantly modifying and tuning a set of learned prediction rules. Fourth, there are applications that need to be customized for each computer user separately. Consider, for example, a program to filter unwanted electronic mail messages. Different users will need different filters. It is unreasonable to expect each user to program his or her own rules, and it is infeasible to provide every user with a software engineer to keep the rules up-to-date. A machine learning system can learn which mail messages the user rejects and maintain the filtering rules automatically. Machine learning addresses many of the same research questions as the fields of statistics, data mining, and psychology, but with differences of emphasis. Statistics focuses on understanding the phenomena that have generated the data, often with the goal of testing different hypotheses about those phenomena. Data mining seeks to find patterns in the data that are understandable by people. Psychological studies of human learning aspire to understand the mechanisms underlying the various learning behaviors exhibited by people (concept learning, skill acquisition, strategy change, etc.).

Machine learning

EASL-EORTC clinical practice guidelines : management of hepatocellular carcinoma

Background and Aims:The lack of consensus on how to define and grade adverse postoperative events has greatly hampered the evaluation of surgical procedures. A new classification of complications, initiated in 1992, was updated 5 years ago. It is based on the type of therapy needed to correct the co

The Clavien-Dindo classification of surgical complications: five-year experience.

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Modern Applied Statistics With S

Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

The dictionary definition of electrolysis is the chemical decomposition by electrical action. World wide, direct current Electrolysis (also known as ‘Electrochemical Therapy’ or ‘ECT’) is probably the second most used form of localised hepatic ablation, after alcohol injection 1-4. The majority of reports are from China and it is unclear why the enormous potential of electrolysis has been overlooked in the West 5. Certainly the diverse nature of the tumours treated by the Chinese and the variably reported methodologies and results make interpretation of the efficacy of electrolysis difficult. It would however seem that there is a large body of anecdotal evidence supporting the safety and efficacy of electrolysis. The technique itself is easily available, simple, relatively cheap and lends itself to a percutaneous approach. In common with all forms of ablative technique, the clinical application has been introduced prior to rigorous scientific evaluation and despite many thousands of clinical cases, the use of ‘electrolysis’ must still be considered experimental.

Direct Current Electrolysis for the Local Ablation of Liver Metastases

Surgery has always been a somewhat dangerous occupation, not only for the patients but also the surgeon. In earlier times, infections secondary to contaminated surgery carried out by the exposed surgeon are well described, heralding the introduction of gloves to protect the surgeon. In more recent years, issues, such as protection from radiation injury because of intraoperative imaging, have been well appreciated, and appropriate preventive and surveillance mechanisms put in place. The article in this issue of the Journal by Moot et al. talks about yet another hazard associated with surgical activity.1 It is quite clear that volatile organic compounds are produced and contained within the diathermy plume. Whether these are of truly clinical significance remains unresolved and controversial. It is, however, unlikely that a clinical study will ever be carried out, which will show that a randomized control group receiving smoke plume on a regular basis can be compared with a group that failed to receive smoke plume. I, for one, would not wish to be randomized into the treatment group and the numbers that would need to be enrolled into such a study to gain significant results would be in the tens of thousands. The cost of follow up would be enormous, ethical approval impossible and a positive result indicating that the diathermy plume was hazardous would, in retrospect, seem to be an expected finding. Where appropriate techniques of extraction exist, as there are now, the utilization of these techniques would be common sense. There are, however, other areas of safety associated with surgical practice, which also need urgent attention and a more proactive approach to their management. Scalpel safety is a significant problem, not only for the surgeon but also for nursing staff.2 The Australian Safety and Efficacy Register of New Interventional Procedures – Surgical is currently looking at techniques of scalpel safely and surgeons will need to take note of the findings, despite the poor evidence base, and perhaps approach scalpel safety in the same way that they have embraced the scrub routine and radiation protection as part of their surgical ritual. Perhaps of even greater concern are the issues of safe working hours associated with surgical practice.3 There is a growing community concern associated with accidents associated with exhausted surgeons. The finding that a surgeon working after 24 h of duty is the equivalent of a drunk driver and recent suicides in the State of Victoria among surgical trainees have, in part, been linked to demanding surgical rosters. These are serious problems of safety, which are difficult to reliably measure. In this age, where evidence-based practice is the catch-cry of administrators, academics and surgeons, it is worth remembering that some interventions do not require irrefutable evidence to warrant their introduction. Diathermy smoke plume can be extracted by available techniques and it makes no sense to wait for the evidence to prove the validity of this approach. Scalpel safety techniques exist now, are relatively inexpensive and should be practised among surgical practitioners without waiting for increased incidences of HIV or hepatitis. Further suicides or patient accidents within the overworked surgical community should not be awaited, but rather the appropriate rosters and work practices should be altered to mitigate their recurrence. Surgery needs to be made as safe as possible, not only for our patients but also for ourselves.

Surgery to die for

The Utilization and National Variation of Plain X-Ray Services by Australian Residents of Long-Term Care Facilities.

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/lt.20834

Response to: Live liver donor mortality

Older Australians are major health service users and early diagnosis is key in the management of their health. Radiological services are an important component of diagnosis and disease management planning in older Australians, but their national utilisation of diagnostic services has never been investigated in Australia.This study aims to evaluate the utilisation of major plain X-rays by Australians ≥ 65 years old.A population-based epidemiological evaluation and yearly cross-sectional analyses of X-ray examinations per 1,000 Australians aged ≥ 65 years old between 2009 and 2019 were conducted using publicly available Medicare Benefits Schedule and Australian Bureau of Statistics data sources. Age and sex specific incidence rate (IR) of plain X-rays per 1,000 Australians, adjusted incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated using a negative binomial regression model.During the study period, the Australian population over 65 years old increased by 39% while the crude plain X-ray utilisation by this population increased by 63%. Most X-rays were conducted on extremities or the chest. Men used chest radiography more than women, and particularly for lungs, where the incidence increased the most in those ≥ 85 years old. There was an increase in X-rays of extremities and the hip joint between 2009-10 and 2013-14 in people ≥ 85 years old.The utilisation of plain X-rays of the chest, the gastro-intestinal tract and extremities was high and has increased among older Australians between 2009-10 and 2018-19. Plain X-rays remain a commonly used diagnostic tool for conditions affecting the older population. 

/pdf/trends-in-utilisation-of-plain-x-rays-by-older-australians-1lsxkkn3.pdf

Guy J. Maddern

Papers

Direct Current Electrolysis for the Local Ablation of Liver Metastases

Surgery to die for

The Utilization and National Variation of Plain X-Ray Services by Australian Residents of Long-Term Care Facilities.

Response to: Live liver donor mortality

Trends in utilisation of plain X-rays by older Australians (2010–2019)