Blinded Evaluation Research Articles

P-579 Preliminary data on family relations in anonymous oocyte donation families: children’s perspectives at age 5 to 7 years

Abstract Study question Do children born in oocyte donation families perceive their relationships with their parents differently than children conceived trough ICSI? Summary answer No significant differences were found in the family relationships between children born in oocyte donation families (OACC) compared with controls (ICSI). What is known already Majority of the previous research concerning relationships in families using oocyte donation focused on the mothers’ perspective. Little is known about how children in these families view their family relationships. Studies investigating young children’s perspectives in donor-families (5-10 years old) indicate good parent-child relationships (Imrie, et al., 2021; Blake, et al., 2013; Casey, et al., 2013). Few of these studies involve young children conceived using anonymous oocyte donation. Study design, size, duration This study included 17 children born through anonymous oocyte donation in heterosexual parents and a comparison group of 13 children conceived ICSI using the heterosexual parents’ own gametes. Data were collected between August 2021 and January 2023. The sample is part of a larger ongoing case-control-study investigating family relationships and the wellbeing of both parents and their children in families created by anonymous oocyte donation. Participants/materials, setting, methods Children were 5 to 7 years old (M = 6.13; SD = 0.5) and had been born after assisted reproduction (ICSI with or without using anonymous oocytes) with their two heterosexual parents. All children were invited to the hospital to undergo biomedical and psychological testing, including the Family Relationship Test (FRT; English version: Bene and Anthony, 1985; Dutch version: Baarda and van Londen, 1985). Multiple blind evaluators were used. Main results and the role of chance No significant differences were found between children born in oocyte donation families (OACC) compared with controls (ICSI). Two-sampled-T-tests show no significant differences for (1) positive feelings (towards and received by children) to their mothers (OACC: M = 6.65, SD = 4; ICSI:M=8.85, SD = 4), fathers (OACC: M = 5.06, SD = 0; ICSI: M = 5.08, SD = 0) or themselves (OACC: M = 0.35, SD = 0.5; ICSI: M = 0.77, SD = 0), (2) negative feelings (towards and received by children) to their mothers (OACC: M = 1.47, SD = 0.5; ICSI: M = 1.92, SD = 4), fathers (OACC: M = 2.06, SD = 0; ICSI: M = 2.31, SD = 0.5) or themselves (OACC: M = 0.76, SD = 0; ICSI: M = 0.38, SD = 0) and (3) dependency to their mothers (OACC: M = 4.29, SD = 3; ICSI: M = 4.54, SD = 0), fathers (OACC: M = 2.82, SD = 1; ICSI: M = 2.69, SD = 2) or themselves (OACC: M = 0.53, SD = 0.5; ICSI: M = 0.85, SD = 0.5). Limitations, reasons for caution This study used multiple evaluators, which may induce a potential evaluators bias. The small sample size limits the validity of our findings to a whole population. As the study is still ongoing, the data to be presented will expand. Wider implications of the findings The findings are relevant to clinics offering anonymous oocyte donation, to (future) parents who used or who considerate using anonymous oocyte donation to create a family. Trial registration number not applicable

Effectiveness of Lumbar Cerebrospinal Fluid Drain Among Patients With Aneurysmal Subarachnoid Hemorrhage

After aneurysmal subarachnoid hemorrhage, the use of lumbar drains has been suggested to decrease the incidence of delayed cerebral ischemia and improve long-term outcome. To determine the effectiveness of early lumbar cerebrospinal fluid drainage added to standard of care in patients after aneurysmal subarachnoid hemorrhage. The EARLYDRAIN trial was a pragmatic, multicenter, parallel-group, open-label randomized clinical trial with blinded end point evaluation conducted at 19 centers in Germany, Switzerland, and Canada. The first patient entered January 31, 2011, and the last on January 24, 2016, after 307 randomizations. Follow-up was completed July 2016. Query and retrieval of data on missing items in the case report forms was completed in September 2020. A total of 20 randomizations were invalid, the main reason being lack of informed consent. No participants meeting all inclusion and exclusion criteria were excluded from the intention-to-treat analysis. Exclusion of patients was only performed in per-protocol sensitivity analysis. A total of 287 adult patients with acute aneurysmal subarachnoid hemorrhage of all clinical grades were analyzable. Aneurysm treatment with clipping or coiling was performed within 48 hours. A total of 144 patients were randomized to receive an additional lumbar drain after aneurysm treatment and 143 patients to standard of care only. Early lumbar drainage with 5 mL per hour was started within 72 hours of the subarachnoid hemorrhage. Primary outcome was the rate of unfavorable outcome, defined as modified Rankin Scale score of 3 to 6 (range, 0 to 6), obtained by masked assessors 6 months after hemorrhage. Of 287 included patients, 197 (68.6%) were female, and the median (IQR) age was 55 (48-63) years. Lumbar drainage started at a median (IQR) of day 2 (1-2) after aneurysmal subarachnoid hemorrhage. At 6 months, 47 patients (32.6%) in the lumbar drain group and 64 patients (44.8%) in the standard of care group had an unfavorable neurological outcome (risk ratio, 0.73; 95% CI, 0.52 to 0.98; absolute risk difference, -0.12; 95% CI, -0.23 to -0.01; P = .04). Patients treated with a lumbar drain had fewer secondary infarctions at discharge (41 patients [28.5%] vs 57 patients [39.9%]; risk ratio, 0.71; 95% CI, 0.49 to 0.99; absolute risk difference, -0.11; 95% CI, -0.22 to 0; P = .04). In this trial, prophylactic lumbar drainage after aneurysmal subarachnoid hemorrhage lessened the burden of secondary infarction and decreased the rate of unfavorable outcome at 6 months. These findings support the use of lumbar drains after aneurysmal subarachnoid hemorrhage. ClinicalTrials.gov Identifier: NCT01258257.

An investigation into the risk of population bias in deep learning autocontouring

Background and PurposeTo date, data used in the development of Deep Learning-based automatic contouring (DLC) algorithms have been largely sourced from single geographic populations. This study aimed to evaluate the risk of population-based bias by determining whether the performance of an autocontouring system is impacted by geographic population. Materials and methods80 Head Neck CT deidentified scans were collected from four clinics in Europe (n = 2) and Asia (n = 2). A single observer manually delineated 16 organs-at-risk in each. Subsequently, the data was contoured using a DLC solution, and trained using single institution (European) data. Autocontours were compared to manual delineations using quantitative measures. A Kruskal-Wallis test was used to test for any difference between populations. Clinical acceptability of automatic and manual contours to observers from each participating institution was assessed using a blinded subjective evaluation. ResultsSeven organs showed a significant difference in volume between groups. Four organs showed statistical differences in quantitative similarity measures. The qualitative test showed greater variation in acceptance of contouring between observers than between data from different origins, with greater acceptance by the South Korean observers. ConclusionMuch of the statistical difference in quantitative performance could be explained by the difference in organ volume impacting the contour similarity measures and the small sample size. However, the qualitative assessment suggests that observer perception bias has a greater impact on the apparent clinical acceptability than quantitatively observed differences. This investigation of potential geographic bias should extend to more patients, populations, and anatomical regions in the future.

The "Claw Sign" may aid in axial localization in cases of peripherally located canine glioma on MRI.

The "claw sign" is a radiographic sign studied in human imaging to determine if a mass arises from a solid structure or organ versus a close adjacent location, resulting in distortion of the outline of an organ. We investigated its utility in characterizing MRI axial localization of peripherally located intracranial glioma versus meningioma, due to their overlap in MRI appearance. This retrospective, secondary analysis, cross-sectional study aimed to report the sensitivity, specificity, and inter- and intraobserver variabilities using kappa statistics, hypothesizing that the claw sign will have strong inter- and intraobserver agreement (κ>0.8). Dogs with a histologically confirmed diagnosis of peripherally located glioma or meningioma and available 3T MRI data were retrieved from medical record archives from 2009 to 2021. A total of 27 cases, 11 glioma and 16 meningioma, were included. The postcontrast T1-weighted images were provided to five blinded image evaluators in two separate randomized sessions separated by a 6-week wash out period. Prior to the first evaluation, evaluators were provided with a training video and set of training cases for the "claw sign," which were excluded from the study. Evaluators were asked to rate cases as "positive," "negative," or "indeterminate" for the "claw sign." The sensitivity and specificity for the "claw sign" for the first session were 85.5% and 80%, respectively. The interobserver agreement for identifying the "claw sign" was moderate (κ=0.48), and the intraobserver agreement across the two sessions was substantial (κ=0.72). These findings indicate the claw sign is supportive but not pathognomonic for intra-axial localization in cases of canine glioma on MRI.

Single energy metal artifact reduction performs better than virtual monoenergetic dual-energy reconstruction in CT of the equine proximal phalanx.

Metal artifacts in CT negatively impact the evaluation of surgical implants and the surrounding tissues. The aim of this prospective experimental study was to evaluate the ability of a single energy metal artifact reduction (SEMAR™, Canon) algorithm and virtual monoenergetic (VM) dual-energy CT (DECT) scanning techniques to reduce metal artifacts from stainless steel screws surgically inserted into the equine proximal phalanx. Seven acquisitions of 18 cadaver limbs were performed on a Canon Aquilion One Vision CT scanner (Helical +SEMAR, Volume +SEMAR, Standard Helical, Standard Volume and VM DECT at 135, 120, and 105keV) and reconstructed in a bone kernel. Blinded subjective evaluation performed by three observers indicated a significant effect of acquisition in both adjacent tissues (P<0.001) and distant tissues (P<0.001) and the best metal artifact reduction was seen with Helical +SEMAR and Volume +SEMAR. The subjective overall preference of CT acquisition type was (1) Helical +SEMAR, (2) Volume +SEMAR, (3) VM DECT 135keV, (4) VM DECT 120keV, (5) VM DECT 105keV, (6) Standard Helical, (7) Standard Volume (P<0.001). Unblinded objective evaluation performed by one observer showed that VM DECT 120keV, Helical +SEMAR, and Volume +SEMAR performed similarly and were objectively the best at reducing blooming artifact. Overall, the best metal artifact reduction was obtained with SEMAR, followed by VM DECT. However, VM DECT performance varies with energy level and was associated with decreased image quality in distant tissues and artifactual overcorrection of metal artifacts at high energy levels.

Impact of an advanced image based monoenergetic reconstruction algorithm on coronary artery stent visualization by dual source dual energy computed tomography: A primary study

ABSTRACT Background: The aim of this study was to investigate the qualities of advanced image based virtual monoenergetic (Mono+) images using a noise optimized algorithm at different kiloelectron volts (keV) compared with linear blended 120 kilovoltage (kV) images in patients with coronary stents. Materials and Methods: Thirty two patients who had undergone coronary computed tomography angiography were retrospectively enrolled in the study. Linear blended 120 kV image and 16 Mono+ images were reconstructed. Quantitative assessments included luminal attenuation difference, in stent image noise, in stent signal to noise ratio (SNR) and contrast to noise ratio (CNR). Double blinded and independent qualitative evaluation of image quality was performed by two readers using a five point scale. Results: The luminal attenuation difference value in the 190 keV group was the lowest. The in stent image noise in the 190 keV group was the lowest, in comparison with that in the 90–180 keV groups; however, it showed no significant difference. The 40 keV group had the highest in stent SNR, and there were no differences between the 40 keV group and the 50–100 keV groups. The 60 keV group had the highest in stent CNR, although no significant difference was found between the 60 keV group and the 40–120 keV groups. The highest subjective score was observed in the 80 keV group, with significant differences from the other groups (P &lt; 0.05), except for the 90 keV group. Conclusion: In comparison with computed tomography image with conventional reconstruction, Mono+ reconstructions at 90 keV can significantly reduce the in stent noise and provide better image quality of coronary stents.

A machine learning–based multidimensional model integrating clinical, radiomics, and cell-free DNA methylation biomarkers for the classification of pulmonary nodules.

3070 Background: Patients with pulmonary nodules undergoing excessive invasive procedures is a pressing clinical problem. We sought to develop a noninvasive, machine learning-based multidimensional tool combining clinical, radiomic, and cell-free DNA (cfDNA) methylation biomarkers for improving accuracy of pulmonary nodules classification. Methods: This prospectively collected and retrospective blinded evaluation trial enrolled a total of 1,276 subjects at 24 hospitals in China. All patients with a 5-30 mm pulmonary nodule at high risk of lung cancer had undergone surgical resection with definitive pathological diagnosis. Clinical information, preoperative peripheral blood, and chest CT scans were collected. The regions of interest (ROIs) containing target nodule on the CT images were automatically segmented by a deep-learning based model. 2,153 radiomics features were extracted from ROIs using PyRadiomics. Based on clinical and radiomics features, four classification models were constructed using LightGBM, Lasso, Random Forest, and Logistic Regression algorithms. Subsequently, the predicted probabilities of the above four models were averaged to obtain a final score of the combined clinical and radiomic biomarkers model (CRBM) in a training set (n=797). Then we integrated CRBM model with our previously established cfDNA methylation model (PulmoSeek; DOI: 10.1172/JCI145973) to create a new combined model using logistic regression (n=201), PulmoSeek Plus V2.0, and verified it independently (n =278). The ROC curves were compared to evaluate the diagnostic performance among the CRBM, PulmoSeek, and PulmoSeek Plus V2.0 model, pathologic diagnosis as the gold standard. Results: The CRBM model achieved AUCs of 0.81(95%CI 0.73-0.90) and 0.80 (0.74-0.86) in the two validation sets (n1=201, n2=278), respectively. In the training set (n=201) and validation set (n=278), the PulmoSeek Plus V2.0 obtained AUCs of 0.93 (0.90-0.97) and 0.91 (0.88-0.95), and accuracies of 0.89 (0.84-0.93) and 0.84 (0.79-0.88), respectively. In the combined set (n=479), when compared with CRBM and PulmoSeek, PulmoSeek Plus V2.0 yielded improved AUCs of 11% and 6%, and accuracies of 6% and 3%, respectively. PulmoSeek Plus V2.0 model for rule-out at the fixed specificity of 50%, had an overall sensitivity of 0.98 (0.96-0.99), PPV of 0.86 (0.82-0.89), and NPV of 0.998 (0.988-1.000, at 5% prevalence). It maintains good diagnostic performance in early-stage lung cancer (0-I, n=328) and 5-10 mm nodules (n=92), with sensitivities of 0.98 (0.96-0.99) and 0.98 (0.92-0.99), respectively. Conclusions: PulmoSeek Plus V2.0, as a novel machine learning-based multidimensional model, improves the accuracy of pulmonary nodules classification, and potentially reduces the unnecessary invasive procedures among individuals with benign nodules. Clinical trial information: NCT03181490 , NCT03651986 .

Evaluation of different methods of environmental enrichment to control anxiety in dogs undergoing hemilaminectomy after acute intervertebral disc extrusion: a randomized double-blinded study.

The goal of this randomized, double-blinded, placebo-controlled study was to evaluate the effect of environmental enrichment (EE) on post-operative pain and anxiety in dogs following hemilaminectomy for acute intervertebral disc extrusion (IVDE). Twenty healthy client-owned dogs undergoing a hemilaminectomy for IVDE with the same immediate post-operative analgesia protocol were randomly assigned to either the EE or standard environment (SE) group post-operatively. Recovery was achieved in an intensive care room (SE) or a separate quiet room (EE) equipped with white noise and classical music. EE dogs were also exposed to dog-appeasing pheromones, essential oil scents, and positive human interactions and were provided meals through food toys. A blinded evaluator assessed all dogs using the modified Glasgow Composite Pain Scale (mGCPS) on presentation and at several time points post-operatively. A rescue injection of the opioid methadone was given to the dogs with an mGCPS score of ≥5/20. Dogs received the antidepressant trazodone when anxious behaviors (5 mg/kg) were observed. The mGCPS scores, the latencies to receive the first methadone and trazodone doses and to eat the first meal, the number of methadone and trazodone doses, and the number of meals ingested in the first 24 and 48 h post-surgery were compared using Wilcoxon tests, and Benjamini-Hochberg correction for false discovery rate was applied. Although median mGCPS scores did not differ between the groups, compared to SE dogs (n = 10), EE dogs (n = 6) received trazodone earlier (p = 0.019), were administered fewer methadone injections at 24 h (p = 0.043), and ate more at 48 h post-surgery (p = 0.007). Therefore, EE and anti-anxiety medications could be beneficial in improving the wellbeing of dogs post-operatively.

Radiological response of leptomeningeal metastases according to revised RANO criteria is associated with overall survival in breast cancer patients.

Assessment of treatment response in patients (pts) with leptomeningeal metastases (LM) represents a significant challenge and standardized criteria are needed. In 2017, the RANO LM Working Group proposed a standardized scorecard to evaluate MRI findings (further simplified in 2019). Here, we aim to validate the prognostic impact of response to treatment assessed using this tool in a multicentric cohort of breast cancer (BC) pts. Pts with BC-related LM diagnosed at two institutions between 2005 and 2018 were identified. Baseline and follow-up MRI scans were centrally reviewed and response assessment was evaluated using 2019 revised RANO LM criteria. A total of 142 pts with BC-related LM and available baseline brain MRI imaging were identified; 60 of them had at least one follow-up MRI. In this subgroup, median overall survival (OS) was 15.2 months (95%CI 9.5-21.0). At first re-evaluation, radiological response by RANO criteria was: complete response (CR) in 2 pts (3%), partial response (PR) in 12 (20%), stable disease (SD) in 33 (55%) and progression of disease (PD) in 13 (22%). Median OS was 31.1 months (HR 0.10, 95%CI 0.01-0.78) in pts with CR, 16.1 months (HR 0.41, 95%CI 0.17-0.97) in pts with PR, 17.9 months (HR 0.45, 95%CI 0.22-0.91) in pts with SD and 9.5 months in pts with PD (P = .029). A second blinded evaluation showed a moderate interobserver agreement (K = 0.562). Radiological response according to 2019 RANO criteria is significantly associated with OS in pts with BC-related LM, thus supporting the use of this evaluation tool both in trials and clinical practice.

A Deep Learning Tool for Automated Landmark Annotation on Hip and Pelvis Radiographs

BackgroundAutomatic methods for labeling and segmenting pelvis structures can improve the efficiency of clinical and research workflows and reduce the variability introduced with manual labeling. The purpose of this study was to develop a single deep learning model to annotate certain anatomical structures and landmarks on antero-posterior (AP) pelvis radiographs. MethodsA total of 1,100 AP pelvis radiographs were manually annotated by 3 reviewers. These images included a mix of preoperative and postoperative images as well as a mix of AP pelvis and hip images. A convolutional neural network was trained to segment 22 different structures (7 points, 6 lines, and 9 shapes). Dice score, which measures overlap between model output and ground truth, was calculated for the shapes and lines structures. Euclidean distance error was calculated for point structures. ResultsDice score averaged across all images in the test set was 0.88 and 0.80 for the shape and line structures, respectively. For the 7-point structures, average distance between real and automated annotations ranged from 1.9 mm to 5.6 mm, with all averages falling below 3.1 mm except for the structure labeling the center of the sacrococcygeal junction, where performance was low for both human and machine-produced labels. Blinded qualitative evaluation of human and machine produced segmentations did not reveal any drastic decrease in performance of the automatic method. ConclusionWe present a deep learning model for automated annotation of pelvis radiographs that flexibly handles a variety of views, contrasts, and operative statuses for 22 structures and landmarks.

Remaining Useful Life Estimation of Spindle Bearing Based on Bearing Load Calculation and Off-Line Condition Monitoring

Spindles are key components of machine tools. An efficient estimation of the spindle condition and its prognosis can improve production efficiency and quality due to predictive maintenance planning. This paper proposes a method for predicting the remaining useful life (RUL) of machine tool spindle bearings using a combined calculation and experimental approach. The calculation model based on the ISO 281 standard uses monitored real loading conditions caused by the machining process and the machine tool operation. The model enables the updated calculation of the spindle lifetime L10h using real load distribution. Since the operation hours of the spindle are also monitored, the remaining useful life (RUL) of the spindle can be calculated. This RUL value is corrected using a bearing condition assessment based on the effective value of the vibration velocity RMS according to the ISO 20816 standard and measured data from the machine tool control system. The proposed method is tested on two different spindle types featuring three pieces of every type. The experimental results of six spindles are compared and validated with a concurrent blind evaluation conducted by a skilled expert. The validation shows a very good match of the proposed method and the expert opinion. The method combining a calculation of the spindle lifetime using monitored real load distribution and subsequent result correction using vibration signal enables the implementation of a full automated estimation of the spindle RUL.

Interval type-2 fuzzy set based block-SBU for image fusion technique

Image fusion is the process of examining one or more obscure images, combining only the critical information in those images to make them a good quality image. Due to the large gap between the high dynamic range of landscape scenes and the low quality of consumer quality cameras, a single-shot image cannot record the information of a single set. A part of image processing called image fusion is used to overcome the above problem. In this method, authors propose a new technology for image fusion with intuitionistic fuzzy sets. During the processing, the given images are converted into fuzzy images and then intuitionistic fuzzy images (IFIs). Thus, a significant change occurs between the given image and IFIs. The resulting IFIs are converted into interval type-2 fuzzy images (IT2FIs) to overcome this problem. The proposed technique is compared to other procedures such as discrete cosine harmonic wavelet transform (DCHWT), multi-resolution single value decay (MSVD), primary component analysis (PCA), standard wavelet transform (SWT), two scale image fusion (TSIF), and wavelet transform (WT). The proposed method gives the best results based on performance analysis such as Entropy, standard deviation (STD), average gradient (AG), mutual information (MIF), and blind referenceless image spatial quality evaluator (BRISQUE). Using the proposed technique, one can obtain the best results for entropy, STD, AG, MIF, and BRISQUE respectively as 7.6241, 49.6745, 69.2100, 5.7276, and 3.3091. Hence it reveals that the proposed method performs better than other methods regarding overall visual quality and performance measurements.

Accuracy Prediction of Compressive Strength of Concrete Incorporating Recycled Aggregate Using Ensemble Learning Algorithms: Multinational Dataset

The use of alternative materials and recycling in construction has gained popularity in recent years as part of the industry’s commitment to sustainability. One such material, recycled aggregates, has been extensively studied over the past two decades for its potential to replace natural aggregates in cement-based composites. However, the unique properties of recycled aggregates make traditional concrete mix design methods ineffective in determining their target compressive strength. To address this challenge, four machine learning models based on ensemble learning algorithms, including CatBoost regressor (CatBoost), light gradient-boosting machine regressor (LGBM), random forest regressor (RFR), and extreme gradient-boosting regressor (XGBoost), were employed to predict the compressive strength of recycled aggregate concrete. Results demonstrate that the proposed models are highly accurate and generalizable, with high coefficients of determination and low error predictions. The CatBoost model performed the best, exhibiting an R2 of 0.938 and low mean absolute error and root mean squared error values of 2.639 and 3.885, respectively, in the blind evaluation process. Although the random forest regression algorithm performed the least well among the four models, it still outperformed conventional machine learning algorithms such as support vector machines and artificial neural networks. The findings in this study suggested that the CatBoost model is the optimal choice for predicting concrete’s compressive strength due to its high accuracy and low prediction error.

In Vitro Radiological Evaluation of Different Types of Chimney Stents Using a Silicon Flow Model with Adjustable Physiological Simulating Conditions

To evaluate invitro the performance of invivo published covered or bare metal chimney stents (ChSs) in combination with the Endurant II abdominal endograft (Medtronic) as the only CE approved main graft (MG) in the treatment of juxtarenal abdominal aortic aneurysms with the chimney endovascular aneurysm repair (chEVAR) technique. Bench top experimental study. A silicon flow model with adjustable physiological simulating conditions and patient based anatomy was used to test nine different MG-ChS combinations: Advanta V12 (Getinge); BeGraft+ (Bentley); VBX (Gore & Associates Inc.); LifeStream (Bard Medical); Dynamic (Biotronik); Absolute Pro (Abbott); double Absolute Pro; Viabahn (Gore) lined with Dynamic; and Viabahn lined with EverFlex (Medtronic). Angiotomography was performed after each implantation. DICOM data were analysed blindly twice per observer by three independent experienced observers. Each blinded evaluation was performed at one month intervals. The main analysed parameters were the area of gutters, MG and ChS maximum compression, and the presence of infolding. Bland-Altman analysis confirmed adequate results correlation (p < .05). Each employed ChS showed significantly different performance favouring the balloon expandable covered stent (BECS). The smallest gutter area was seen in the combination with Advanta V12 (0.26 cm2). MG infolding was observed in all tests. The lowest ChS compression was observed in the combination with BeGraft+ (compression 4.91%, D ratio 0.95). In our model, BECSs showed higher angulations than bare metal stents (BMSs) (p < .001). This invitro study shows the variability of performance with each theoretically possible ChS and explains the divergent ChS outcomes in the published literature. BECS in combination with the Endurant abdominal device confirms their superiority vs. BMS. The presence of MG infolding in each test underlines the need for prolonged kissing ballooning. Angulation evaluation and comparison with other invitro and invivo publications demands the need for further investigation in transversely or upwardly oriented target vessels.

Urinary proteomics combined with home blood pressure telemonitoring for health care reform trial-First progress report.

High blood pressure (BP) and type-2 diabetes (T2DM) are forerunners of chronic kidney disease and left ventricular dysfunction. Home BP telemonitoring (HTM) and urinary peptidomic profiling (UPP) are technologies enabling risk stratification and personalized prevention. UPRIGHT-HTM (NCT04299529) is an investigator-initiated, multicenter, open-label, randomized trial with blinded endpoint evaluation designed to assess the efficacy of HTM plus UPP (experimental group) over HTM alone (control group) in guiding treatment in asymptomatic patients, aged 55-75 years, with ≥5 cardiovascular risk factors. From screening onwards, HTM data can be freely accessed by all patients and their caregivers; UPP results are communicated early during follow-up to patients and caregivers in the intervention group, but at trial closure in the control group. From May 2021 until January 2023, 235 patients were screened, of whom 53 were still progressing through the run-in period and 144 were randomized. Both groups had similar characteristics, including average age (62.0 years) and the proportions of African Blacks (81.9%), White Europeans (16.7%), women 56.2%, home (31.2%), and office (50.0%) hypertension, T2DM (36.4%), micro-albuminuria (29.4%), and ECG (9.7%) and echocardiographic (11.5%) left ventricular hypertrophy. Home and office BP were 128.8/79.2mmHg and 137.1/82.7mmHg, respectively, resulting in a prevalence of white-coat, masked and sustained hypertension of 40.3%, 11.1%, and 25.7%. HTM persisted after randomization (48 681 readings up to 15 January 2023). In conclusion, results predominantly from low-resource sub-Saharan centers proved the feasibility of this multi-ethnic trial. The COVID-19 pandemic caused delays and differential recruitment rates across centers.

Contrasting features between Tourette syndrome and secondary tic disorders.

Tics are rapid, recurrent, non-rhythmic movements or emitted sounds. Tics are the hallmark of Tourette syndrome (TS); however, a number of other disorders may be associated with tics, so-called secondary tic disorders (STD). We assessed clinical history and performed blinded evaluations of video-recordings from patients with TS and STD in order to identify features that may differentiate tics associated with TS vs STD. There were 156 patients with TS and 38 with STD, 21 of whom had functional (psychogenic) tics. Patients with TS were more frequently male and had a younger age at onset. Tics in TS tend to involve muscles in the cranial-cervical area more often and have greater severity and complexity than those in patients with STD. Similar findings were observed when contrasting patients with TS with patients with functional tics only. Simple phonic tics showed the greatest diagnostic accuracy for TS, compared with STD, but marked overlap in the types of tics and comorbidities was observed between patients with TS and STD. Patients with TS were more likely males, had a younger age at onset, phonic tics and motor tics affecting predominantly the head and neck area, and had a greater complexity and severity of tics than those with STD. When these features are absent a consideration should be given to the possibility of a tic disorder other than TS.

The reliability/ validity of cognitive/emotional approaches to the evaluation of musical performance: Implications for competition juries

Procedures to evaluate the quality of musical performance, like psychological tests generally, vary in reliability and validity. How can both be optimised? The subjective world of jurors comprises input (sensations) and output (thoughts and emotions). Cognitive approaches to performance evaluation, in which different aspects are analytically considered and the results combined, are more reliable than emotional approaches, which are ultimately based on holistic ‘gut reactions’. However, emotional approaches may be more valid. Both depend on the serial order in which performances are presented to evaluators, suggesting a need for independent, computer-controlled procedures in which jurors evaluate performances in different random orders. Jurors can be influenced by performers’ appearance and movements, as well as knowledge about past performances, whether or not they believe they should be; additional blind evaluations (sound only) could help. Evaluations may depend primarily on specific features such as right-hand melodic phrasing in romantic piano music. It would be interesting to systematically track the emotional state of jurors during a competition in order to better understand the interaction between their thoughts and emotions. In general, traditional approaches to performance evaluation might be supplemented (not replaced) by psychologically inspired, computer-based procedures. A ‘superjury’ could compare evaluations from different methods or ‘subjuries’.

Impact of uptake time on image quality of [68 Ga]Ga-PSMA-11 PET/CT.

With the introduction of prostate specific membrane antigen (PSMA) PET/CT, the detection rate of prostate cancer metastases has improved significantly, both for primary staging and for biochemical recurrence. EANM/SNMMI guidelines recommend a 60min time interval between [68 Ga]Ga-PSMA administration and acquisition. This study evaluates the possibility of a shorter time interval by investigating the dynamic change in image quality measures. We retrospectively analyzed 10 consecutive prostate cancer patients who underwent a dynamic whole body [68 Ga]Ga-PSMA-11 PET/CT of 75min from skull vertex to mid-thigh using Siemens FlowMotion. PET images were acquired directly after injection of 1.5MBq/kg [68 Ga]Ga-PSMA-11. Image quality measures included lesion maximum standardized uptake value corrected for lean body mass (SULmax ), tumor-to-background ratio (TBR), and contrast-to-noise ratio (CNR). Quantitative analysis of image quality in dynamic PET was performed using PMOD (version 4.2). Regions of interest (ROIs), drawn included different types of prostate lesions (primary tumor, lymph nodes, and bone metastasis), organ tissue (liver, spleen, lacrimal gland, submandibular gland, parotid gland, urinary bladder, kidneys blood pool [ascending aorta], left ventricle), bone tissue (4th lumbar vertebral body [L4]) and muscle tissue (gluteus maximus). To further investigate image quality four 10min multi-frame reconstructions with clinical parameters were made at different post-injection times (15, 30, 45, and 60min). A nuclear medicine physician performed a blinded lesion detectability evaluation on these multi-frame reconstructions for different prostate cancer lesions. Six primary prostate tumors in seven patients with prostate in situ, 13 lymph node metastases in six patients and up to 12 bone metastases in three patients were found. The different prostate lesion types (lymph nodes metastases, bone metastases, and primary prostate tumor) all show an increase in average SULmax , TBR, and CNR over time during the scan. The normalized average SULmax , TBR, and CNR of the combined prostate lesions at 15, 30, and 45min post-injection scans were all significant p<0.05 lower from the 60min post-injection [68 Ga]Ga-PSMA-11 PET/CT (9.5±4.5, 12.7±6.2, and 41.8±24.5, respectively). At patient level, the reader concluded the same regarding the presence/absence of primary prostate cancer recurrence, lymph node metastases, and/or bone metastases on all <60min post-injection [68 Ga]Ga-PSMA-11 PET/CT's in comparison to the reference scan (60min post-injection). At lesion level, all bone metastases seen on the reference scan were also seen on all <60min post-injection [68 Ga]Ga-PSMA-11 PET/CT's but there were some lymph nodes (n=2) metastases missed on the 15, 30, and 45min post-injection scans. One lymph node metastasis on both the 15 and 30min post-injection [68 Ga]Ga-PSMA-11 PET/CT's was missed and one lymph node metastasis was missed, only on the 45min post-injection [68 Ga]Ga-PSMA-11 PET/CT. Shorter post-injection times (15, 30, and 45min) compared to the recommended post-injection time of 60min are not optimal. However, the impact of a shorter time interval of 45min instead of 60min between [68 Ga]Ga-PSMA-11 administration and the start of PET/CT acquisition on both image quality (SULmax , TBR, and CNR) and lesion detection, while significant, is small.

Blinded by the person? Experimental evidence from idea evaluation

AbstractResearch SummarySeeking causal evidence on biases in idea evaluation, we conducted a field experiment in a large multinational company with two conditions: (a) blind evaluation, in which managers received no proposer information, and (b) non‐blind evaluation, in which they received the proposer's name, unit, and location. To our surprise—and in contrast to the preregistered hypotheses—we found no biases against women and proposers from different units and locations, which blinding could ameliorate. Addressing challenges that remained intractable in the field experiment, we conducted an online experiment, which replicated the null findings. A final vignette study showed that people overestimated the magnitude of the biases. The studies suggest that idea evaluation can be less prone to biases than previously assumed and that evaluators separate ideas from proposers.Managerial SummaryWe wanted to find out if there were biases in the way managers evaluate ideas from their employees. We did a field experiment in a large multinational technology company where we tested two different ways of evaluating ideas: one where managers did not know anything about the person who came up with the idea and one where they did know the person's name, which unit they worked for, and where they were located. The results were surprising. We did not find any bias against women and employees that did not work in the same location and unit as the evaluator. Managers are advised that hiding the identity of idea proposers (from idea evaluators) may not be a silver bullet to improving idea evaluation.

Effectiveness of neurobic exercise program on memory performance in community-dwelling older adults with mild cognitive impairment: A randomized controlled crossover trial.

Mild cognitive impairment (MCI) is an early stage of cognitive decline in individuals who are still able to perform their activities of daily living. They are at increased risk of developing dementia. Improving and maintaining cognitive functions are essential goals for older people with MCI to delay or prevent the transition to dementia. This study investigated the effect of the neurobic exercise program on memory performance among community-dwelling older adults with MCI. A single-blind, randomized, controlled, two-period crossover design was used. Thirty-two older adults who met the study criteria were randomly assigned to one of two sequence groups, A (n =16) and B (n = 16). Group A received three weeks of neurobic exercise, followed by a three-week washout period, and then three weeks of the traditional brain exercise program. Group B received the treatments in the reverse order but otherwise in a similar manner. Two aspects of memory performance were evaluated: subjective memory and objective memory. Blinded evaluators measured the outcomes four times at baseline, post-intervention (week 3), follow-up stage (week 7), and the end of the study (week 9). Descriptive statistics, independent t-tests, and repeated measures ANOVA were employed for data analyses. For subjective memory, rmANOVA revealed a significant difference of within-subject (F1.437, 43.113 = 9.324, p <0.05) and interaction effect (time*group) (F1.437, 43.113 = 12.313, p <0.05) and also showed significant differences of within-subject (F1.794,53.811 = 28.931, p < .05) and interaction effect (time*group) (F1.794, 53.811 = 31.190, p <0.05) for objective memory. The study results revealed that the participants in both groups had significantly lower mean scores on the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), indicating better or improved subjective memory. They also had significantly higher mean scores on the Common Objects Memory Test (COMT) after receiving the neurobic exercise program, indicating improvement in cognitive performance. The neurobic exercise intervention could improve subjective and objective memory among community-dwelling older adults with MCI more than those who received the traditional brain exercise program. Therefore, the neurobic exercise program can be used by nurses and multidisciplinary teams to enhance memory performance among older adults with MCI. Thai Clinical Trials Registry (TCTR) 20210326003.