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Artificial intelligence (AI) is transforming the field of medicine. However, expansion and adoption of AI applications in the intraoperative domain has been more challenging. To understand why, it is crucial to examine the current state of intraoperative AI (iAI) from multiple perspectives, including research, engineering, and industry. In this review, we provide a comprehensive analysis of iAI technology by conducting a systematic review of both clinical and technological literature, consolidating an up-to-date database of AI devices that are FDA and CE approved for use in surgical settings, and analysing the trend of globally filed patents and research from industry. Our analysis provides an accurate depiction of the latest abilities, limitations, and potential of iAI. We propose future directions and challenges that need to be addressed to expedite the adoption of iAI, given that the current level of implementation may not fully align with the expectations generated by the significant attention and interest in AI technologies. Thus, it is imperative to fill this critical gap in literature to enable the realisation of the vast potential of iAI in transforming surgical practice.

A systematic review protocol for maternal health outcomes associated with child custody loss. The aim of this review is to synthesize the evidence of health outcomes associated with child removal amongst women in high-income countries. To this end, the proposed systematic review will answer the following questions: 1. What are the physical health outcomes associated with child removal for women? 2. What are the mental health outcomes associated with child removal for women?

Evaluation of various interventions through network meta-analysis to look at their effectiveness on linear growth in children aged 0-6 months.

Background: Improving the health of pregnant women is important to prevent adverse birth outcomes, such as preterm birth and low birthweight. We evaluated the comparative effectiveness of interventions under the domains of micronutrient, balanced energy protein, deworming, maternal education, and water sanitation and hygiene (WASH) for their effects on these adverse birth outcomes. Methods: For this network meta-analysis, we searched for randomized clinical trials (RCTs) of interventions provided to pregnant women in low- and middle-income countries (LMICs). We searched for reports published until September 17, 2019 and hand-searched bibliographies of existing reviews. We extracted data from eligible studies for study characteristics, interventions, participants’ characteristics at baseline, and birth outcomes. We compared effects on preterm birth ( Results: Our network meta-analyses were based on 101 RCTs (132 papers) pertaining to 206,531 participants. Several micronutrients and balanced energy food supplement interventions demonstrated effectiveness over standard-of-care. For instance, versus standard-of-care, micronutrient supplements for pregnant women, such as iron and calcium, decreased risks of preterm birth (iron: RR=0.70, 95% credible interval [Crl] 0.47, 1.01; calcium: RR=0.76, 95%Crl 0.56, 0.99). Daily intake of 1500kcal of local food decreased the risks of preterm birth (RR=0.36, 95%Crl 0.16, 0.77) and LBW (RR=0.17, 95%Crl 0.09, 0.29), respectively when compared to standard-of-care. Educational and deworming interventions did not show improvements in birth outcomes, and no WASH intervention trials reported on these adverse birth outcomes. Conclusion: We found several pregnancy interventions that improve birth outcomes. However, most clinical trials have only evaluated interventions under a single domain (e.g. micronutrients) even though the causes of adverse birth outcomes are multi-faceted. There is a need to combine interventions that of different domains as packages and test for their effectiveness. Registration: PROSPERO CRD42018110446; registered on 17 October 2018.

Background:Optimizing linear growth in children during complementary feeding period (CFP) (6-24 months) are critical for their development. Several interventions, such as micronutrient and food supplements, deworming, maternal education, and water, sanitation and hygiene (WASH), could potentially be provided to prevent stunting, but their comparative effectiveness is currently unclear. In this study, we evaluated comparative effectiveness of interventions under these domains on child linear growth outcomes of height-for-age z-score (HAZ) and stunting (HAZ Methods:For this study, we searched for low- and middle-income country (LMIC)-based randomized clinical trials (RCTs) of aforementioned interventions provided to children during CFP. We searched for reports published until September 17, 2019 and hand-searched bibliographies of existing reviews. We performed random-effects network meta-analysis (NMA) for HAZ and stunting.Results:The evidence base for our NMA was based on 79 RCTs (96 papers) involving 81,786 children. Among the micronutrients, compared to standard-of-care, iron + folic acid (IFA) (mean difference =0.08; 95% credible interval [CrI]: 0.01, 0.15) and multiple micronutrients (MMN) (mean difference =0.06; 95%CrI: 0.01, 0.11) showed improvements for HAZ; MMN also reduced the risks for stunting (RR=0.86; 95%Crl: 0.73, 0.98), whereas IFA did not (RR=0.92; 95%Crl: 0.64, 1.23). For food supplements, flour in the caloric range of 270-340 kcal (RR=0.73; 95%Crl: 0.51, 1.00) and fortified lipid-based nutrient supplements (LNS) containing 220-285 kcal (RR=0.80; 95%Crl: 0.66, 0.97) decreased the risk of stunting compared to standard-of-care, but these interventions and other food supplements did not show improvements for HAZ. Deworming, maternal education, and WASH interventions did not show improvements for HAZ nor stunting.Conclusion:While we found micronutrient and food supplements to be effective for HAZ and/or stunting, the evidence base for other domains in this life stage was limited, highlighting the need for more investigation.Registration:PROSPEROCRD42018110449; registered on 17 October 2018.

There has been a rapid expansion in the use of non-randomized evidence in the regulatory approval of treatments globally. An emerging set of methodologies have been utilized to provide greater insight into external control data used for these purposes, collectively known as synthetic control methods. Through this paper, we provide the reader with a set of key questions to help assess the quality of literature publications utilizing synthetic control methodologies. Common challenges and real-life examples of synthetic controls are provided throughout, alongside a critical appraisal framework with which to assess future publications.

Collaboration and successful teamworking are important components of clinical practise, and these skills should be cultivated early in medical school. The breadth of current medical school curricula means that students often have limited exposure to clinical neurosciences. Since its inception in 2009, the Neurology and Neurosurgery Interest Group (NANSIG) has become a national (UK and Republic of Ireland) example of student and junior doctor synergistic collaboration to deliver educational materials, research, conferences, seminars and workshops, as well as advocating for diversity in this field. Recently, it has expanded to incorporate an international audience and cater for a larger group of young medical professionals. The organisation has overcome numerous challenges and is constantly innovating new approaches to harness the necessary knowledge, skills and network to succeed in a career in neurosciences, neurology and neurosurgery. This article summarises the initiatives undertaken by the group over its first 10 years of existence and its organisational structure, as well as its future plans.

Randomized clinical trials (RCT) are an important tool that has led to important reduction of global childhood mortality. Low and middle-income countries (LMICs) still face important challenge in stunting (low height-for-age) that can produce detrimental effects on child’s long-term development. Facing important challenges in stunting Rwanda has adopted stunting prevention with a particular focus on complementary feeding period ([CFP]: 6-24 months) as their national strategic plan. Rapid Pro, a community health workers program that provides routine health and monitoring services from pregnancy to five years of age using SMS, is a unique health system in Rwanda that can be used to improve linear growth for their children. A single overarching master protocol for an adaptive platform trial (APT) that could be embedded into Rapid Pro to determine comparative effectiveness of multi-component interventions on linear growth during CFP was developed. APTs are a new RCT design that allows for evaluation of multiple interventions against a common control using interim evaluation and flexibilities of allowing new interventions to be added during the trial. To inform the trial design, a landscape analysis of master protocols and APTs was done through a systematic literature review (SLR). This showed 83 master protocols, 16 of which were platform trials, that have been mostly conducted in the US (n=44/83) for pharmaceutical development (n=82/83). This was followed by an SLR with network meta-analysis (NMA) of LMIC-based RCTs studying interventions under the domains of micronutrients and food supplements, deworming, maternal education, and water, sanitation, and hygiene aimed to improve linear growth for children during CFP. An NMA of 79 RCTs involving 81,786 children showed largely equivocal results highlighting the need for more investigation with interventions being combined and tested as packages. The results of these findings were then presented to the governmental stakeholders to determine intervention packages to be tested and to inform the APT design. Simulations were performed to design Bayesian early stopping rules that could reduce the expected sample size while keeping type I error rates under 2.5%. The findings support the use of APTs for child health and other key areas in global health research.