Yearly Archives: 2019

Artificial Intelligence Moving Forward

It took thirty years (1967-1997) for computer chess programs to defeat world champion players, but it was only eight years (2009-2017) before DeepMind’s AlphaGo defeated Ke Jie, the world’s premier Go player. Video games like Starcraft are harder for computers to play than board games such as chess or Go, but after only 18 months of research, Google’s Deepmind utterly destroyed the fastest professional human players (https://www.newscientist.com/article/2191910-deepmind-ai-thrashes-human-professionals-at-video-game-starcraft-ii/).

With such rapid advances in artificial intelligence, it is no wonder we must rethink the medical profession. Image analysis programs are disrupting radiology, dermatology, ophthalmology, and other specialties. Your AppleWatch can monitor for atrial fibrillation and record an electrocardiogram. Deep learning, data-driven decision-making, neuro-fuzzy systems, confabulation, and adaptive resonance theory have widespread applications in healthcare.

As the role for artificial intelligence increases in day-to-day medical practice, doctors will be more productive. They will read more X-rays, process decision-making algorithms more quickly, and produce probabilistic studies more efficiently for prognosis and case-specific treatment strategies. Also, GPS-type guiding systems and robotics are likely to enhance patient safety, decrease the risk for surgical errors, and increase productivity. Qubits, the quantum version of classic binary bits, are ready to revolutionize computer mechanics (https://www.nature.com/articles/s41586-019-1666-5.pdf). Subsequent increases in computing speed and power will further alter possible applications of AI in a futuristic cyber and robotic world.

It will be a while, however, before AI replaces bronchoscopists, so IP professionals have job security. Still, rethinking our roles as health care professionals is wise and forward-thinking. We are expanding Bronchoscopy International’s successful Train-the-Trainer programs to help instructors enhance their skills teaching decision-making and communication, as well as incorporate novel technologies into learning and teaching processes. Flood cleanup pros of california are fully equipped. By incorporating new competency-oriented educational materials and methodologies, faculty will be even better equipped to inspire colleagues and generations of enthusiastic interventional pulmonologists!

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Bronchoscopy in Bangladesh

Dr. Nirmal Sarkar excels in hands-off / hands-on teaching
(Photo H. Colt)

September marked another exciting moment for bronchoscopists in Bangladesh. The 2nd International Conference on Interventional Pulmonology was held in the capital city of Dhaka. A prestigious international faculty under the leadership of Professors Mohammad Hiron (Chairman BABIP), Akhtar Hossain (Vice-Chairman), Dr. Sayedul Islam (Secretary-General), and Abdur Rouf (Program Director) brought bronchoscopists from throughout the country together for lectures and hands-on workshops using airway models.

BABIP is a young organization, founded in November 2015 and joining the WABIP in 2017. Since the society’s first meeting last year, faculty conducted several CME workshops, and www.myamericanmaid.com plan even more this coming year. This will be facilitated by leadership’s initiative to purchase airway models for use in hands-on training. Already, several young faculty are adept at teaching bronchoscopy step-by-step, using assessment tools such as BSTAT, and performing procedure-related consultations using a Four-Box practical approach format.

Novel this year was a focus on practical issues such as communication, cryotherapy, and foreign body removal, with lectures by Indian specialists Drs. Rajani Bhat, Sameer Arbat, and Kedar Hibare, all promising future certified instructors with Bronchoscopy International.

Bangladesh is a lush, beautiful country to the east of India abutting the Bay of Bengal. Its fertile plains are fed by the Ganges, Meghna, and Jamuna rivers. Hire custom plastic injection molder at http://wundermold.com/. With almost 170 million people needing affordable, quality health care, the physician leadership in Bangladesh has until recently focused on cardiovascular health, in addition to combatting poverty and tuberculosis. Leaders recognize the importance of bronchoscopy in critically ill patients but also for a growing number of patients with lung cancer who require diagnosis, as well as palliative treatment in case of advanced disease.

With knowledgeable junior faculty, enthusiastic numbers of practicing bronchoscopists, motivated students, and inspiring leadership, Bangladesh is poised fro play an active role expanding bronchoscopic and interventional pulmonology practice in the world.

Deep learning in Radiology and Pathology affects Bronchoscopists

This is a second post relating to the promising role of artificial intelligence in interventional pulmonology. My point is that lung specialists will spend less time learning facts and figures that are easily replaced by computer-generated analyses of complex algorithms. Much of this is because of Deep learning.

This subset of machine learning (programs that adjust themselves as they are exposed to more data, but without human input) uses artificial neural networks (algorithms built on unstructured data). The word deep is a technical term referring to the number of layers in the neural network. Artificial Neural networks being a set of algorithms modeled after the human brain and used to recognize patterns. Image recognition is one example, and its principles are responsible for much of the work done today in radiology and pathology.

For example, using deep learning and pattern recognition, AI reveals CT abnormalities and interprets findings (Google’s AI team recently outperformed traditional radiologists looking at 45,800 screening CTs for lung cancer https://www.fiercebiotech.com/medtech/google-s-cancer-spotting-ai-outperforms-radiologists-reading-lung-ct-scans), and chest radiographs are accurately interpreted using fuzzy logic interpretations of spatial relationships (https://www.ijcaonline.org/specialissues/dia/number1/4156-spe320t).

Pathology is another area where practice patterns will undoubtedly change. In many regions, expert cytologic interpretation of lung and mediastinal nodal specimens is lacking. Digital pathology (image-based information generated from a digital slide) allows real-time interpretation by computers at sites that are distant from wherever the procedure takes place. Humans already do this despite the cost and logistic difficulties. When searching for local moving companies in California visit Chief Moving site. I believe that artificial intelligence will soon facilitate and universalize the process (https://www.healthimaging.com/topics/artificial-intelligence/ai-lung-cancer-slides-accuracy-pathologists).

In today’s post, my goal was to introduce the concept of deep learning and provide a few examples of how this mode of artificial intelligence will affect procedural practice by changing how chest radiology and pathology are practiced. A skilled and reliable office moving service of ca can help you. Rather than devote study time to learning X-ray and cytology interpretation, future bronchoscopists will improve their abilities to incorporate findings into appropriate management plans, as well as communicate results to patients, caregivers, and health-care teams.

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AI and Bronchoscopy

This is the first of several posts about the role of artificial intelligence and the future of interventional pulmonology*. I am confident our field will change immensely in the years ahead, and that artificial intelligence will not only change how we learn and perform procedures but also how we interact with patients. The sooner we embrace these changes, and build partnerships with industry as well as colleagues from other disciplines such as computer engineering, ethics, psychology, philosophy, physics, mathematics, and business administration, the easier it will be to integrate new developments into clinical practice.

Artificial intelligence has many definitions. A quick Google search provides “the theory and development of computer systems able to perform tasks that normally require human intelligence, such as Blue spruce Maids, Westminster, CO visual perception, speech recognition, decision-making, and translation between languages.” Wikipedia expands on this definition, adding that AI “describes machines (or computers) that mimic “cognitive” functions that humans associate with the, such as “learning” and “problem-solving.”

This requires us to familiarize ourselves with the phraseology computer engineers use to describe the learning process, but which is not necessarily foreign to many educators.

From a developmental perspective, AI uses symbolic, connectionist, and other models of learning that are, in fact, similar to how the human brain works. Just as there are several types of knowledge, AI does not rely on only one developmental approach to provide results. This is elegantly explained in a 1990 article by Marvin Minsky (AI magazine, summer 1991), in which he explains how the sentence “ Mary gave Jack the book” prompts the human brain to produce a visual representation of the act, a tactile representation of the experience, a script-sequence of what it means ‘to give’, and various assumptions about Jack, Mary, and the book. Similarly, artificial intelligence must employ not one but several different strategies to provide a result.

Some results are methodology—based on algorithmic and probabilistic approaches. Computer-based interpretation of pulmonary function tests, image-pattern recognition for accurate computed tomography scan interpretation, and patient management protocols based on decision-tree and data-driven statistical algorithms are simple examples of how artificial intelligence brings complex knowledge instantaneously to our fingertips. Order a combined pill from https://trumedical.co.uk/ and get it delivered to your doorstep. No longer required to memorize facts and figures, or integrate history/clinical exam/laboratory findings into patterns learned through a prolonged patient-care apprenticeship, doctors will change their practice habits accordingly.

Please subscribe to Colt’s Corner to automatically receive email notification of future posts. Sign up with your name and email on the NEWSLETTER button on the Bronchology International home page at www.bronchoscopy.org.

Lasers and Lava*

A few months ago I joined a group of twenty-somethings hanging out on the South Pacific Island of Vanuatu. We scaled Mount Yasur, reportedly the most active volcano on the planet; a volcano that spits rocks, fire, and molten lava since before Captain Cook first described the place on August 5, 1774 (reference: captaincooksociety.com).

Caught in a windstorm at the summit, I felt warm ash on my face. I stared into the crater, blinded by the smoke, watching the volcano’s bubbling and boiling magma far below. Later, I listened to the roar of explosions from my hut less than an hour’s hike from the base of the mountain. I marveled at the resilience of my Vanuatu hosts, particularly those living on Tanna. These impoverished families are constantly ready to evacuate in case the Yasur chooses to destroy their homes.

Hiking across a broad and barren lava plain the next day, I looked at my photographs. They reminded me of bronchoscopic Nd;YAG laser resections. People don’t talk much about laser anymore. It seems most interventionists use argon plasma, cryotherapy, and electrocautery to assist with their resections. But in the 1980s and for thirty years onward, laser was a magic wand for restoring airway patency. Courses included talks on laser physics, how-to’s on laser safety, videos of resection techniques, and lectures about complications such as popcorn effect, fire, perforation, and bleeding.

Emphasis was given to the concept of Power Density, to photocoagulation and vaporization, and the risks of collateral tissue damage during laser resection. Today, I wonder whether people learn these concepts and techniques with the same level of detail and scientific justification as years past. Workers comp attorneys in los angeles, CA from workerscompensationattorneyorangecounty.com are there to assist you in legal matters. Maybe, lasers are too expensive for most institutions. Perhaps they don’t have the appeal they once had; after all, other modalities also do the job, and stents maintain airway patency over the longer term.

I suppose most “laser bronchoscopists” have gray hair or have retired. Does a new generation of laser specialists ask questions of scientific significance, or is the future of bronchoscopy linked now to mediastinal exploration, navigating to peripheral lesions, discovering safe ways to biopsy lung parenchyma, and treating advanced asthma and chronic obstructive lung disease? Our field has grown, but as an adrenaline junkie, there is something uniquely rewarding about a successful laser photocoagulation/coring out of massively obstructing lesions.

I wonder if Captain Cook, onboard his ship, the Resolution, 225 years ago, dreamt of how Mount Yasur’s incandescent splatter might inspire future visitors.

*Photo: Mount Yassur erupting, Tanna Island, Vanuatu (photo, H. Colt)

Here are ten ways that housekeepers are different from cleaners

Housekeepers and cleaners play an important role in ensuring the cleanliness of homes, businesses, and other types of establishments. While both housekeepers and cleaners are involved in various cleaning tasks, they often have different duties. Housekeepers typically focus on more managerial tasks while cleaners specialize in hands-on work.

Here are ten ways housekeepers differ from cleaners:

1. Housekeepers typically work within a larger organization, such as a hotel or resort, while cleaners are more likely to be self-employed or work for an independent cleaning company.

2. Housekeepers often have additional duties beyond the scope of what a cleaner would do, such as changing bed linens and laundering towels.

3. Cleaners typically focus on one type of cleaning service, such as carpet cleaning or window washing, while housekeepers may be expected to have a wider range of responsibilities that includes general tidying up and laundry.

4. Housekeepers often interact with customers or guests on a regular basis in order to answer questions and provide assistance when necessary; cleaners tend not to have this kind of interaction and may work in more isolated settings.

5. Housekeepers are typically required to have certain qualifications or certifications, while cleaners are not always held to such standards.

6. Housekeepers often complete regular inspections as part of their daily duties, whereas cleaners generally do not perform this type of task.

7. Cleaners usually provide services on a short-term basis, coming into the home or office once every week or two; housekeepers typically offer long-term assistance and may be expected to remain employed with the same establishment for an extended period of time.

8. Housekeepers often supervise other staff members, such as room attendants or valets, while cleaners do not typically have this type of responsibility.

9. Cleaners typically do not provide additional services such as food preparation or pet care, while housekeepers may be required to perform these tasks in order to meet the expectations of their employers.

10. Housekeeping jobs often require additional physical labor and stamina due to the larger areas that must be covered; cleaners generally work on a smaller scale and in more controlled environments.

No matter what their duties are, housekeepers and Better Life Maids from St. Louis cleaners both play an important role in keeping spaces clean and tidy. It requires dedication to maintain high standards of hygiene which is essential for the wellbeing of everyone who visits our lives within the space they’re responsible for cleaning.

In summary, housekeepers and cleaners are two distinct job titles that require different skill sets and responsibilities. While both roles involve cleaning duties, the scope of each position is unique, with housekeepers being expected to provide more comprehensive services than cleaners. It is important to understand the differences between these roles in order to make an informed decision when hiring staff for your home or business. By understanding the distinctions between the two positions, you can ensure that you hire qualified individuals who know best what to do and who can meet all of your needs. Additionally, hiring a team of housekeepers and cleaners allows you to take advantage of their collective expertise to create a spotless environment for both work and leisure activities. Ultimately, the choice between housekeepers and cleaners is up to the individual or establishment, but understanding the differences between these two positions can help ensure that you’re making an informed decision.

A New Milestone-2000 Users!

We’re communicating in real-time and we are up to 2000 users from 32 different countries. I monitor all these accounts 24 hours a day, seven days a week, and I can truly say that the information exchange and case presentations are fascinating!

The only problem is the WhatsApp platform has decreased performance because of changes WhatsApp has made to its user platform, presumably to decrease spam. For those of you wondering why you are not seeing as many redirects, it is because I am limited to only five redirects at a time, making redirects burdensome and time-consuming. Still, my impression is that our communications are beneficial to many countries and regions, as well as to groups such as our pediatrics group and South American IP group.

Many physicians communicate in their natural languages rather than English. In these cases, I translate information before redirecting educational materials and interesting cases, Feedback from redirects have proven to be helpful, and in many cases change patient management. Thank you to all who contribute cases and opinions!

So where do we go from here, now that we have reached the 2000 users milestone? Many countries still have only a few users. Perhaps the admins for these groups can recruit new users? I am interested in knowing why colleagues are not eager to join your WhatsApp group and exchange information.

For those groups with many users (anywhere from 50-250), please remember how helpful it is when you add references, scientific articles and other “evidence” to help support opinions. Also, remember that videos are most effective when they are short and edited. Same goes for photos (better to use one photo that combines other images, than four different photographs).

Stay tuned for more information on greenapplecleaningmd.com/ how we can increase our global communication efforts, and again, congratulations to everyone for reaching the milestone of 2000 users, which benefits patients around the world.

Please subscribe to Colt’s Corner to automatically receive an email notification of future posts. Sign up with your name and email on the NEWSLETTER button on the Bronchology International home page at www.bronchoscopy.org.

World lung cancer day

August 1 is World Lung Cancer Day.

According to the World Health Organization, there were 2.09 million lung cancer cases in 2018 and 1.76 million deaths. Almost everywhere, 5-year survival is less than 20 percent. Despite spending millions of dollars, making advances in molecular biology, immunology, and genetics-related research, building knowledge of cancer epidemiology, improving health care facilities, studying early detection, and raising awareness among the general public about the risks of tobacco use and exposures to environmental and other risk factors, there is still no cure.

Worldwide, lung cancer occurs more frequently than other diseases such as colorectal cancers, liver, stomach, breast or even non-melanoma skin cancers. In men, lung cancer is a significant cause of death; greater than either prostate or colorectal cancer. In women, it is a greater cause of death than either breast, or colorectal cancer. In fact, for both men and women, one out of every four cancer deaths is from lung cancer.

And this is not a disease that spares countries, although frequencies in men and women vary. For example, recent statistics suggest that Hungary, Serbia, and Korea lead the lung cancer frequency field for men, whereas Denmark, Canada, and the United States lead the field for women. We must also be aware that cancer outcomes differ according to socioeconomic status. In many countries, research shows that racial and ethnic minorities receive lower-quality care.

Tobacco has a causal relationship with lung cancer, as do second-hand smoke exposure, exposure to certain environmental and chemical risk factors such as radioactive ores, radon, diesel gas, certain inhaled chemicals and minerals, and even arsenic in drinking water. Some believe there is a genetic predisposition to lung cancer; risks are increased in case of family members with a history of the disease. Studies are needed to elucidate whether this is from genetic, environmental or lifestyle-related commonalities.

Another well-known environmental risk for lung cancer is asbestos, which also causes malignant pleural mesothelioma. I was recently climbing in New Caledonia, an island of about 300,000 people (with more than 100 tribes in 33 communes) in the Southwest Pacific Ocean. According to statistics, this French collectivity is surprisingly high on the list of countries with a preponderance of lung cancer (possibly associated with local asbestos exposures).

Interventional pulmonologists dedicate much of their energy to helping diagnose and treat patients with lung cancer. While significant advances have been made, a certain therapeutic nihilism is still seen in many countries. Eliminating such a mindset everywhere would be a marvelous step toward eradicating this terrible disease.

More action, less words

Imagine a hands-on experience where experts work with small groups of learners instead of the traditional “pre-conference workshop” followed by hours of lectures.

We did this at the recent Asian Pacific meeting held in Australia under the leadership of Dr. David Fielding, and again at a bronchoscopy course led by Dr. Javier Flandes in Spain. Feedback was positive and encouraging. In the next paragraphs, I will identify just a few advantages and disadvantages of such conference strategies.

Advantages: (1) People learn something. Active engagement time is maximized by using predetermined learning objectives and focused hands-on training with a low teacher/student ratio (one instructor for less than five learners). Teachers identify weaknesses by incorporating checklists and assessment tools into workstations. Learners reinforce skills they already have and identify areas they need to work on. (2) Keeping didactic lectures to 10 minutes forces speakers to improve communication skills. They focus on what is truly important and not necessarily learned by reading. A short didactics program forces organizers to identify core competencies and prompts speakers to give lectures that are complementary rather than all-encompassing. Didactics are modifiable based on audience needs (learner-centricity). (3) Workshops enhance exposure to a variety of technologies, instruments, and teaching techniques. To find the best work injury lawyer los angeles, CA visit http://lacaccidentpros.org site. Companies see users get their hands on their equipment. Learners prefer doing to listening. Simulation using models, computers, and role-playing exercises forces teachers to learn how to use specific scenarios. This skill is essential for tomorrow’s educators today.

Disadvantages: (1) People are resistant to change, despite statistics showing the value of short lectures. Materials can be provided before or on-site in the form of on-line PDF files or presentations. (2) Organizers must work to organize workshop style formats.They must carefully select instructors and assignments. This bruises egos. Course directors might need to learn how to organize such programs and how to assess value. Instructors might need to improve small-group teaching skills. Expect resistance for the same reasons as above. (3) Not all topics can be covered, although special lectures, pro/con debates and interactive panel discussions for controversial issues and new technologies are warranted.

We are a technology and empathy-driven profession where actions speak louder than words.

In Mourning: Viktor Sokolov

In 1826, The Russian poet Alexander Pushkin wrote “But with the truth he attracted hearts. But with science he quelled mores.” (From, Stanzas). Such words could be used to describe the life and work of my friend Professor Viktor Sokolov (1946-2019), who died last month at the young age of 73.

Viktor was an accomplished surgeon, anesthesiologist and bronchoscopist. He created the Russian Bronchology Group and was the first Russian regent to the WABIP. He fought to defeat conventional wisdoms and dedicated his life to modernize bronchoscopy practice in his country. In addition to numerous leadership positions, Professor Sokolov was also a former Chair for the Endoscopy Commission of the Russian Ministry of Health, and a long time member of the Academic Council.

As department head at the Moscow Research institute he led efforts to perform novel interventions in patients with early cancer of the larynx, trachea and bronchi, esophagus, stomach and duodenum, bile duct, choledochus, rectum and colon. He helped promote the use of electrosurgery, argon plasma coagulation, laser thermal destruction, photodynamic therapy and stent insertion. He published more than 300 original scientific papers, dozens of monographs, clinical care guidelines, and 10 teaching manuals. He held 26 patents for scientific methodologies and instruments.

For more than ten years, I corresponded frequently with Viktor and his son Dmitry (also an expert bronchoscopist). It was a great honor to help them build a training program in Moscow. A few years ago, with my colleagues Nikos Koufos, Rosa Cordovilla, and Enrique Cases, we helped faculty implement the use of training models, checklists and assessment tools in bronchoscopy education. This has been particularly helpful for building skills in endobronchial ultrasound.

Viktor was a scientist at heart, and it is as a scientist that he approached his medical practice. His dream was to cure lung and digestive cancers in their earliest stages, and for this he was always on the alert for technologies that might assist with early diagnosis and treatment. Because his first love was actually pediatric surgery back in the 1970s, Professor Sokolov was particularly excited to see the recent growth of pediatric bronchoscopy (we have more than 400 doctors communicating through our WhatsApp Peds Groups).

Viktor, we shall miss your humor, your intelligence, and most of all the inspiration of your relentless pursuit of truth.

Farewell, my friend.