Field Rate Research Articles

Prostate cancer screening : to be recommended in 2024?

The Prostate Specific Antigen (PSA) blood test is still the only screening tool for prostate cancer. It is recommended between the ages of 50 and 69 as part of a shared decision making process between a patient and his or her doctor using a decision aid, as the test carries a significant risk of overdiagnosis. If a patient wishes to be screened, either because he is at higher risk, or because he places greater importance on a modest reduction in cancer-related mortality, the frequency of screening depends on his age, family history, and whether he is part of a high-risk group. The use of multiparametric MRI after a positive PSA result can reduce the number of biopsies and, consequently, the risk of overdiagnosis.

Factors associated with cervical cancer screening among women attending gynecological consultations at the Maroua Regional Hospital, Cameroon

This study aimed to assess the factors associated with cervical cancer screening at the Maroua Regional Hospital. A cross-sectional study was conducted among 376 women aged ≥25 years attending gynecological consultations at the Maroua Regional Hospital between February and May 2023. Data were collected through a structured questionnaire survey. These factors were evaluated through multiple logistic regression analyses, and associations were established by calculating the odds ratios, confidence intervals, and p-values. A total of 376 women were interviewed. Their mean age was 39.21 ± 10.45 years. Of the 376 women, 9.3% had already been screened for cervical cancer. Results of multivariate analyses indicated that age ≥45 years, belief that every woman should be screened at age 25 years, perceived need for frequent screening, use of screening as a preventive measure, and having had first intercourse before age 15 years or between ages 15 and 20 years significantly increased the likelihood of having been screened. Strategies need to be developed to improve access to cervical cancer screening services in Cameroon by strengthening existing screening programs and effectively implementing campaigns to improve access to screening services.

Adaptive frequency driving scan driver based on a‐InGaZnO TFTs for extremely low‐power displays

AbstractIn this paper, we propose a novel scan driver combined with a logic circuit using amorphous indium‐gallium‐zinc‐oxide (a‐InGaZnO) thin‐film transistors (TFTs) in order to enhance the electrical stability and reduce power consumption in display panels. The latest mobile displays with high resolution and refresh rates consume more battery power, which inevitably limits portability and usability. The proposed scan driver can mask the signal by combining the output stage with a logic circuit, thereby blocking the output pulse for static images. This allows the display panel to operate in a partial driving mode depending on the display content. Due to the masking of the scan driver's output pulses, the connected pixel circuits are consistently maintained in the same state as the previous frame, leading to a lower refresh rate and reduced power consumption. Furthermore, by constructing additional control signals, the proposed scan driver can operate stably in depletion mode under a ∆VTH = −3 V.

Sexually Transmitted Infections in Pre-Exposure Prophylaxis Patients

Background: Pre-exposure Prophylaxis (PrEP) has revolutionized HIV prevention, but concerns exist about its potential impact on other Sexually Transmitted Infections (STIs). This study aimed to assess the prevalence and patterns of STIs among PrEP users at a single urban clinic. Methods: We conducted a retrospective analysis of 100 patients on PrEP, evaluating STI diagnoses over a 12-month period. Comprehensive STI screening was performed quarterly, including nucleic acid amplification tests for chlamydia and gonorrhea at multiple anatomical sites, and serological testing for syphilis. Results: Of the 100 participants (mean age 32.5 years, 82% men who have sex with men), 42% were diagnosed with at least one STI during the study period. The most common infections were chlamydia (28%), gonorrhea (18%), and syphilis (8%). Among chlamydia and gonorrhea cases, 60.9% were rectal infections. Fifteen percent of patients experienced multiple STI diagnoses. Factors independently associated with STI diagnosis included age <30 years (OR 2.1, 95% CI: 1.3-3.4), ≥5 sexual partners in the past 6 months (OR 2.8, 95% CI: 1.7-4.6), and inconsistent condom use (OR 1.9, 95% CI: 1.2-3.0). Conclusion: This study demonstrates a high prevalence of STIs among PrEP users, emphasizing the need for comprehensive STI prevention, frequent screening, and prompt treatment in this population. While PrEP effectively prevents HIV transmission, it must be implemented as part of a holistic approach to sexual health to address the risk of other STIs.

Playback method for dynamic star map simulation by fusing cosmic background radiation information

In this study, a playback method for dynamic star map simulation fusing cosmic background radiation information was proposed to improve the playback speed of star maps. The image distortion effect before and after the fusion of star maps and cosmic background radiation was evaluated using peak signal-to-noise ratios. The performance of the proposed and the global catalog traversal generation algorithms without cosmic background radiation simulation capability, as well as the indicators, were experimentally compared. The results showed that the average refresh rates of the view cone filtering star map fast-generation algorithm and the fusion playback algorithm of the star map and cosmic background radiation were 74.2 and 73.7 Hz, respectively. Compared with the entire catalog traversal generation algorithm, the instantaneous stability of the single-frame star map was improved by 3.045 and 3.305 times, respectively, and the consumed time consistency was improved by 4.646 and 5.068 times, respectively.

Liquid Crystal Display with High Transmittance and Excellent Image Quality

High transmittance and excellent image quality are two crucial requirements for thin-film transistor liquid crystal displays (TFT-LCDs). This work presents a novel pixel structure utilizing a vertical alignment liquid crystal (VA-LC) to improve both transmittance and image quality. The new pixel structure, called TCL-pixel, features a unique transparent conducting layer (TCL) that constructs an electric field shielding layer and a large transparent storage capacitor, resulting in good stability and a large aperture ratio. The 55" 8K product incorporating the TCL-pixel achieves high transmittance (3.87%) and a high contrast ratio (5100:1), attributed to the large aperture ratio. Additionally, it exhibits negligible vertical cross talk (0.7%), low color cross talk (3‰), low horizontal cross talk (JND 2.3), and enhanced variable refresh rate performance, confirming its good stability. Furthermore, the TCL-pixel demonstrates an improved viewing angle (CESI 0.03：65°) due to the multi-domain alignment produced by the transparent conducting layer.

To Determine the Risk-Based Screening Interval for Diabetic Retinopathy: Development and Validation of Risk Algorithm from a Retrospective Cohort Study.

The optimal screening interval for diabetic retinopathy (DR) remains controversial. This study aimed to develop a risk algorithm to predict the individual risk of referable sight-threatening diabetic retinopathy (STDR) in a mainly Chinese population and to provide evidence for risk-based screening intervals. The retrospective cohort data from 117,418 subjects who received systematic DR screening in Hong Kong between 2010 and 2016 were included to develop and validate the risk algorithm using a parametric survival model. The risk algorithm can be used to predict the individual risk of STDR within a specific time interval, or the time to reach a specific risk margin and thus to allocate a screening interval. The calibration performance was assessed by comparing the cumulative STDR events versus predicted risk over 2 years, and discrimination by using receiver operative characteristics (ROC) curve. Duration of diabetes, glycosylated hemoglobin, systolic blood pressure, presence of chronic kidney disease, diabetes medication, and age were included in the risk algorithm. The validation of prediction performance showed that there was no significant difference between predicted and observed STDR risks in males (5.6% vs. 5.1%, P=0.724) or females (4.8% vs. 4.6%, P=0.099). The area under the receiver operating characteristic curve was 0.80 (95% confidence interval [CI], 0.78 to 0.81) for males and 0.81 (95% CI, 0.79 to 0.83) for females. The risk algorithm has good prediction performance for referable STDR. Using a risk-based screening interval allows us to allocate screening visits disproportionally more to those at higher risk, while reducing the frequency of screening of lower risk people.

Low Power Emission Pulse Generation Circuit Based on n-Type Amorphous In-Ga-Zn-Oxide Transistors for Active-Matrix Organic Light-Emitting Diode Displays

This paper presents a low power emission (EM) pulse generation circuit using n-type amorphous In-Ga-Zn-Oxide (a-IGZO) semiconductor thin-film transistors (TFTs). The low power consumption is achieved by avoiding the shoot-through current paths through an optimized inverter circuit. The proposed circuit consists of 12 TFTs and 2 capacitors including 6 TFTs and 1 capacitor for the inverter circuit to control the pulling-down TFTs. In addition, the wider variance range of the threshold voltage (Vth) from −4 V to 2.5 V is covered by additional 6 TFTs for series-connected two transistor (STT) schemes and two low supply voltages to take into account the negative Vth of depletion-mode TFTs. The simulation of 30 EM circuits is conducted over a 6.1-inch active-matrix organic light-emitting diode display of 120 Hz refresh rate and 3840 × 2160 (UHD) resolution. The power consumption of the EM circuit with the proposed inverter is measured at the low values from 0.836 mW to 0.568 mW over pulse widths from 3 to 2157 horizontal times. It is ensured that the proposed circuit achieves the low power consumption regardless of pulse widths.

Ultra‐High Secure Holographically Steganographic Array with Spatiotemporal Dual‐Encryption Keys

AbstractIndependently‐manipulated optical encryption has attracted great attention due to its high security and multiple application scenarios. Although photochromic molecules have become preferred holographic display units, the integration of dynamic modulation both in hologram and fluorescence for orthogonal encryption is still challenged. Herein, a latticed holographically steganographic array is constructed by incorporating a plasticizer (tri‐o‐cresyl phosphate, TOCP) into spirooxazine (SO) based polymers, thereby modulating the isomerization rate and the UV‐fluorescence kinetics between SO and merocyanine (MC). The period to reach fluorescence saturated value for each information bit in the latticed device can be widely modulated between 60 and 1700 s. Based on the property, only through ultraviolet stimulation can array information gradually be converted from spatial lattice coordinates to holographic display time. Then, a hidden 3D image can be determined from rapidly updatable reconstructed hologram video with refresh rate 1.125 Hz by the above spatiotemporal dual‐encryption keys. This work provides a bright path for the ultra‐high safety steganography and adaptive stereoscopic imaging.

Transferrin saturation is a superior prognostic biomarker for iron deficiency after acute decompensated heart failure: a retrospective clinical real-world cohort study

Abstract Background Iron deficiency (ID) is the most common extracardiac comorbidity in heart failure (HF) and associated with worse outcomes. While a uniform definition of ID in HF remains lacking, several biomarkers for ID, including ferritin and transferrin saturation (TSAT), are used in both clinical trials and clinical practice. However, which biomarker is a superior prognostic predictor for ID in HF remains unsettled. In addition, real-world clinical data on ID screening and intravenous (IV) iron treatment is largely missing. Purpose To determine which biomarker is a superior prognostic predictor for the composite endpoint of HF rehospitalisation (HHF) and all-cause mortality in a real-world cohort of patients with HF and coexisting ID, and to investigate frequency and predictors of ID screening and IV iron treatment. Methods In this retrospective cohort study, all patients aged 18-85 years hospitalised at a tertiary university hospital with new onset HF with reduced ejection fraction (HFrEF) in 2016-2020 were consecutively included from medical records by ICD-10 code I50.0-I50.9 and followed until 31 December 2021. Patient characteristics, comorbidities, medications, laboratory results and data on follow-up, including if ID was tested for, IV iron administration, HHF and all-cause mortality was collected. First available iron status after admission for index hospitalisation was used. Predictors for ID screening and IV iron use were identified with univariate logistic regression. The association between ID markers and the composite endpoint was analysed with Cox regression adjusted for age, sex, baseline anemia, estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 and N-terminal pro-B type natriuretic peptide (NT-proBNP) below median value with median ferritin and TSAT values set as references respectively. Results In all, 753 patients were included (66.5 ± 12.7 years, 508 (67.5%) men, ejection fraction 29.5 ± 6.9% and mean NT-proBNP 6241 ± 7183 ng/L). Of these, 484 (64.3%) were screened for ID and 235 (48.6%) fulfilled criteria for ID. Of these, 94 (40.0%) received IV iron. Of screened patients, 28.6% had ID with anemia and 20.8% ID without anemia (Table 1). Factors associated with screening for ID were follow-up at hospital, anemia, eGFR <30 mL/min/1.73 m2 and ischemic heart disease, and for IV iron additionally chronic kidney disease and peripheral artery disease. Median ferritin was 140 µg/L and TSAT 0.2. Both ferritin and TSAT displayed an inversely linear association with outcomes, while TSAT <0.2 showed a stronger association with increased risk of HHF and all-cause mortality compared to median values (Figure 1-2). Conclusions In a real-world clinical setting, TSAT was a superior prognostic biomarker for worse outcomes compared to ferritin in patients hospitalised for acute HF. While both ID screening and IV iron use remained greatly underutilised in clinical practice, identification of a reliable biomarker for ID is critical.

Highly accurate absolute optical transfer delay measurement over a long distance assisted by the pulse time signal

In this paper, an absolute optical transfer delay measurement method based on pulse time signal, pseudo-random code phase, and microwave phase is proposed. By employing two-stage integer ambiguity resolution, not only can a measurement range of several hundred kilometers be achieved, but sub-picosecond level measurement accuracy can also be attained. A test system was built in the laboratory and experimentally verified on a fiber optic link. The experimental results verify an accuracy of ±0.1 ps in measuring an ultrahigh-accuracy optical delay line. In addition, long fiber is also tested, which proves that a measurement range of at least 100 km can be achieved. The refresh rate of the measurement results can reach 100 ms each time.

Adherence to recommended follow-up in opportunistic versus non-opportunistic cervical screening: a registry-based cohort study from Denmark.

Organised cervical screening programmes often allow for opportunistic screening. Previous studies have shown that adherence to follow-up protocols after cervical screening is poor. This study aims to investigate if non-adherence to recommended screening intervals - that is, opportunistic screening, is associated with adherence to follow-up after non-negative cervical screening. Using national registries we included 42,399 Danish women with a non-negative screening result from 2015 to 2017. Non-adherence was divided into insufficient and excessive follow-up. We calculated relative risks (RRs) of adherence to follow-up among different groups of opportunistically screened women, representing both too frequent and delayed screening participation, compared with non-opportunistically screened women. Compared with non-opportunistically screened women, opportunistically screened women who were delayed 1-3 years on their screening schedule had a higher risk of no follow-up (RR 1.99) and insufficient follow-up (RR 1.10). Women who were delayed 3-7 years on their screening also had a higher risk of no follow-up (RR 1.92). Women who attended screening up to 6 months too early had a higher risk of insufficient follow-up (RR 1.08) as well as excessive follow-up (RR 1.39). Finally, women screened more than 6 months too early had a higher risk of all deviations, but most pronounced was the risk of excessive follow-up (RR 1.67). We found a higher risk of insufficient follow-up among women delayed in their screening schedule, and a higher risk of excessive follow-up among those with frequent screening. Screening participation behaviour seems to transfer to follow-up adherence. This underscores the important role of general practitioners in acting as gatekeepers in cervical screening follow-up.

10 Optimizing implementation and continuous monitoring of a newborn screening program for severe combined immunodeficiency

Abstract Background Severe Combined Immunodeficiency (SCID) is an inborn error of immunity characterized by severely low T cell levels and function. Early diagnosis is essential to prevent serious infections and improve outcomes. Newborn screening (NBS) for SCID provides a way to detect SCID and other conditions associated with T cell lymphopenia in the neonatal period. Objectives 1) Optimize the implementation of a NBS program for SCID in British Columbia (BC), Canada; and 2) create a systematic method for monitoring the diagnoses and outcomes of infants with a positive screen to facilitate continuous improvement of the NBS program. Design/Methods An interdisciplinary working group comprised of immunologists, biochemical geneticists, and hematopathologists met at regular intervals prior to and after implementing NBS for SCID in BC. We developed an algorithm for the evaluation and initial management of infants with an abnormal NBS for SCID based on literature review and local expert consensus. Using a REDCap database, we tracked the prevalence, evaluation, diagnoses and outcomes of infants with a positive NBS. The database also monitored diagnoses and outcomes of children referred to Immunology outside of the NBS program. Plan-do-study-act cycles included creation of clinical and educational guidelines on SCID, optimization of abnormal NBS cut-off values, and reflex chromosomal microarray (CMA) testing of infants with confirmed T cell lymphopenia. Results Between October 3, 2022 and June 16, 2023, 28,816 initial samples were tested, and 30 infants had a positive screen for SCID. Of the 30 infants, 10 were ultimately diagnosed with conditions associated with T cell lymphopenia. Diagnosis led to avoidance of live viral vaccines and implementation of infection precaution measures. No infants experienced complications related to live viral vaccine administration, compared to 1 case in the preceding 12 months prior to NBS implementation. In February 2023, the threshold for an abnormal NBS was adjusted to achieve the goal positive screen frequency of 0.1%. Performing reflex CMA testing on infants with confirmed T cell lymphopenia led to rapid diagnosis of chromosomal microdeletion syndromes, avoiding unnecessary second tier testing. Since implementing NBS for SCID in BC, there have been no cases of SCID diagnosed outside of the NBS program. Conclusion Establishing an interdisciplinary working group and clinical database facilitated the smooth integration and continuous improvement of NBS for SCID in BC. This model can be applied to other healthcare systems to support teams and ensure the best possible outcomes for affected patients.

Active Choice Nudge to Increase Screening for Primary Aldosteronism in At-Risk Patients.

Primary aldosteronism (PA) is the most common cause of secondary hypertension, yet screening remains startlingly infrequent. We describe: 1) PA screening practices in a large, diverse health system, 2) the development of a computable phenotype for PA screening, and 3) the design and pilot deployment of an electronic health record (EHR)-based active choice nudge to recommend PA screening. A multidisciplinary team developed a multi-pronged intervention to improve PA screening informed by guidelines, expertise, and multivariable analyses of factors associated with screening. The intervention included EHR-based tools to automatically identify screen-eligible patients, an active choice nudge recommending screening for these patients, and screening result interpretation. The intervention was piloted across two primary care practices for seven months. Screening frequencies were compared to clinics not receiving the intervention. The baseline frequency of screening of eligible patients within one year was 1.4%. Higher mean systolic blood pressure (OR=1.4; p<0.001), more antihypertensive medications (OR=1.3; p=0.002), lower minimum serum potassium (OR=2.0; p=0.001), specialist care (OR=3.0; p<0.001), and Black race (OR=1.5; p=0.001) were associated with a higher likelihood of screening. The refined computable phenotype identified a subcohort with a higher frequency of positive screening (8.6% versus 4.1%; p=0.03). In a pilot study of an active choice nudge, a greater proportion of eligible patients were screened in the intervention clinics (16.4%) than in the non-intervention clinics (1.8%; p<0.001). PA screening rates are low. This pilot study suggests an EHR-based nudge leveraging a precise computable phenotype can dramatically increase appropriate PA screening.

Magnetic resonance cavitation imaging for the monitoring of ultrasound therapies

Objective.Focused ultrasound (FUS) is a promising non-invasive therapeutic approach that can be used to generate thermal and non-thermal bioeffects. Several non-thermal FUS therapies rely on FUS-induced oscillations of microbubbles (MBs), a phenomenon referred to as cavitation. Cavitation monitoring in real time is essential to ensure both the efficacy and the safety of FUS therapies. This study aims to introduce a new magnetic resonance (MR) method for cavitation monitoring during FUS therapies.Approach.By finely synchronizing the FUS pulse with an accelerated turbo spin-echo MR sequence, the cavitation effect could be quantitatively estimated on the acquired images at 1-Hz refresh rate. The proposed method was assessed in vitro in a water bath. A series of FUS pulses were generated on a silicone tube filled with MBs at different acoustic pressures (0.07-2.07 MPa) and pulse durations (20-2000μs). MR images and passive cavitation detection (PCD) signals were simultaneously acquired for each FUS pulse.Main results.Inertial cavitation was found to induce a quantitatively interpretable signal loss on the MR image. The transition from stable to inertial cavitation was identified on MR cavitation maps with high repeatability. These results were found to be in good agreement with PCD measurements in terms of pressure thresholds between stable and inertial cavitation. MR cavitation imaging was shown to be sensitive to short and even ultrashort FUS pulses, from 2 ms down to 20μs. The presented theoretical model suggests that the signal loss in MR cavitation imaging relies on susceptibility changes related to the diameter of the oscillating MBs.Significance.The proposed MR cavitation imaging method can both locate and characterize cavitation activity. It has therefore the potential to improve the efficacy and safety of FUS therapies, particularly for localized drug delivery applications.

Body composition as a biomarker for assessing future lung cancer risk.

To investigate if body composition is a biomarker for assessing the risk of developing lung cancer. Low-dose computed tomography (LDCT) scans from the Pittsburgh Lung Screening Study (PLuSS) (n=3,635, 22 follow-up years) and NLST-ACRIN (n=16,435, 8 follow-up years) cohorts were used in the study. Artificial intelligence (AI) algorithms were developed to automatically segment and quantify subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), intramuscular adipose tissue (IMAT), skeletal muscle (SM), and bone. Cause-specific Cox proportional hazards models were used to evaluate the hazard ratios (HRs). Standard time-dependent receiver operating characteristic (ROC) analysis was used to evaluate the prognostic ability of different models over time. The final composite models were formed by seven variables: age (HR=1.20), current smoking status (HR=1.59), bone volume (HR=1.79), SM density (HR=0.29), IMAT ratio (HR=0.33), IMAT density (HR=0.56), and SAT volume (HR=0.56). The models trained on the PLuSS cohort achieved a mean AUC of 0.76 (95% CI: 0.74-0.79) over 21 follow-up years and 0.70 (95% CI: 0.66-0.74) over the first 7 follow-up years for predicting lung cancer development within the PLuSS cohort. In contrast, models trained on the PLuSS cohort alone, as well as in combination with the NLST cohorts, achieved an AUC ranging from 0.61 to 0.68 in the NLST cohort over a 7-year follow-up period. Body composition assessed on LDCT is a significant predictor of lung cancer risk and could improve the effectiveness of LDCT lung cancer screening by optimizing the screening eligibility and frequency. Body composition assessed on LDCT is a significant predictor of lung cancer risk and could improve the effectiveness of LDCT lung cancer screening by optimizing the screening eligibility and frequency. This study unveils the significant associations between body tissues and lung cancer risk.The prediction models based on body composition alone, as well as the combination of demographics and body composition features can effectively identify patients at higher risk of developing lung cancer.

Understanding the risk of ionizing radiation in breast imaging: Concepts and quantities, clinical importance, and future directions

BackgroundConventional mammography remains the primary imaging modality for state-of-the-art breast imaging practice and its benefit (both on diagnostic and screening) was largely reported. In mammography, the typical Mean Glandular Dose (MGD) from X-ray radiation to the breast spans, on average, from 1 to 10 mGy, depending on breast thicknesses, percentage of fibroglandular tissue, and on the examination purpose. MethodsThe aim of this narrative review is to describe the extent of radiation risk in X-ray breast imaging and discuss the main steps and parameters (e.g. MGD, screening frequency and number of examination views) that may have an influence on the radiation risk assessment. ResultsEven though the radiation doses used with these examinations are very low, as compared to other medical or natural radiation exposures, there is a non-negligible associated risk of radiation-induced cancer. Accurate radiation risk assessment permits to better balance the overall estimation of the benefit-to-risk ratio in X-ray breast imaging. ConclusionsIt is expected that a better knowledge about radiation-induced cancer risk among population could improve the communications skills between patients and clinicians and could help to increase the awareness in women about radiation risk perception for a transparent and proper informed choice of imaging exam.

Investigation of the Reproducibility of Portable Optical Coherence Tomography in Diabetic Macular Edema

Background: Diabetic macular edema (DME) causes vision impairment and significant vision loss. Portable optical coherence tomography (OCT) has the potential to enhance the accessibility and frequency of DME screening, facilitating early diagnosis and continuous monitoring. This study aimed to evaluate the reliability of a portable OCT device (ACT100) in assessing DME compared with a traditional stationary OCT device (Cirrus 5000 HD-OCT plus). Methods: This prospective clinical investigation included 40 eyes of 33 patients with DME. Participants with significant refractive errors (myopia &gt; −6.0 diopters or hyperopia &gt; +3.0 diopters), vitreous hemorrhage, tractional retinal detachment, or other ocular diseases affecting imaging were excluded. Spectral-domain OCT was performed by a single examiner using both devices to capture macular volume scans under mydriasis. Central macular thickness (CMT) was evaluated using the analysis software for each device: Cirrus used version 6.0.4, and ACT100 used version V20. We analyzed inter-evaluator and inter-instrument agreements for qualitative assessments of the intraretinal fluid (IRF), subretinal fluid (SRF), and epiretinal membrane (ERM) using Cohen’s kappa coefficient, whereas quantitative CMT assessments were correlated using Spearman’s correlation coefficient. Results: Substantial inter-evaluator agreement for IRF/SRF (κ = 0.801) and ERM (κ = 0.688) with ACT100 and inter-instrument agreement (κ = 0.756 for IRF/SRF, κ = 0.684 for ERM) were observed. CMT values measured using ACT100 were on average 29.6 μm lower than that of Cirrus (285.8 ± 56.6 vs. 315.4 ± 84.7 μm, p &lt; 0.0001) but showed a strong correlation (R = 0.76, p &lt; 0.0001). Conclusions: ACT100 portable OCT demonstrated high reliability for DME evaluations, comparable to that of stationary systems.

Frequency of Screening and Spontaneous Breathing Trial Techniques

The optimal screening frequency and spontaneous breathing trial (SBT) technique to liberate adults from ventilators are unknown. To compare the effects of screening frequency (once-daily screening vs more frequent screening) and SBT technique (pressure-supported SBT with a pressure support level that was >0-≤8 cm H2O and a positive end-expiratory pressure [PEEP] level that was >0-≤5 cm H2O vs T-piece SBT) on the time to successful extubation. Randomized clinical trial with a 2 × 2 factorial design including critically ill adults who were receiving invasive mechanical ventilation for at least 24 hours, who were capable of initiating spontaneous breaths or triggering ventilators, and who were receiving a fractional concentration of inspired oxygen that was 70% or less and a PEEP level of 12 cm H2O or less. Recruitment was between January 2018 and February 2022 at 23 intensive care units in North America; last follow-up occurred October 18, 2022. Participants were enrolled early to enable protocolized screening (more frequent vs once daily) to identify the earliest that patients met criteria to undergo pressure-supported or T-piece SBT lasting 30 to 120 minutes. Time to successful extubation (time when unsupported, spontaneous breathing began and was sustained for ≥48 hours after extubation). Of 797 patients (198 in the once-daily screening and pressure-supported SBT group, 204 in once-daily screening and T-piece SBT, 195 in more frequent screening and pressure-supported SBT, and 200 in more frequent screening and T-piece SBT), the mean age was 62.4 (SD, 18.4) years and 472 (59.2%) were men. There were no statistically significant differences by screening frequency (hazard ratio [HR], 0.88 [95% CI, 0.76-1.03]; P = .12) or by SBT technique (HR, 1.06 [95% CI, 0.91-1.23]; P = .45). The median time to successful extubation was 2.0 days (95% CI, 1.7-2.7) for once-daily screening and pressure-supported SBT, 3.1 days (95% CI, 2.7-4.8) for once-daily screening and T-piece SBT, 3.9 days (95% CI, 2.9-4.7) for more frequent screening and pressure-supported SBT, and 2.9 days (95% CI, 2.0-3.1) for more frequent screening and T-piece SBT. An unexpected interaction between screening frequency and SBT technique required pairwise contrasts that revealed more frequent screening (vs once-daily screening) and pressure-supported SBT increased the time to successful extubation (HR, 0.70 [95% CI, 0.50-0.96]; P = .02). Once-daily screening and pressure-supported SBT (vs T-piece SBT) did not reduce the time to successful extubation (HR, 1.30 [95% CI, 0.98-1.70]; P = .08). Among critically ill adults who received invasive mechanical ventilation for more than 24 hours, screening frequency (once-daily vs more frequent screening) and SBT technique (pressure-supported vs T-piece SBT) did not change the time to successful extubation. However, an unexpected and statistically significant interaction was identified; protocolized more frequent screening combined with pressure-supported SBTs increased the time to first successful extubation. ClinicalTrials.gov Identifiers: NCT02399267 and NCT02969226.

Physio-avatar EB: aftereffects in error learning with EMG manipulation of first-person avatar experience.

Many studies have investigated the manipulation of a virtual upper arm using electromyogram (EMG); however, these studies primarily used a machine learning model or trigger control for this purpose. Furthermore, most of them could only display the constant motion of the virtual arm because the motion to be displayed was selected by pattern recognition or trigger control. In addition, these studies did not examine changes in the electromyographic signals after experiencing the virtual arm. By contrast, we propose a real-time, continuous, learning-free avatar that manipulates the virtual arm with electromyogram signals or physio-avatar EMG biofeedback (EB). The goal of the physio-avatar EB system is to induce physiological changes through experiential interactions. We explored the possibility of changing motor control strategies by applying the system to healthy individuals as a case study. An intervention method that provided an experience of a body different from one's own was conducted on seven participants using a time-invariant calculation algorithm to determine the joint angles of the avatar. Control strategies for an indicator of the equilibrium point in the baseline and adaptation phases were determined to evaluate the physio-avatar EB intervention effect. The similarity of these BL and adaptation control strategies compared to those used during the washout period was assessed using the coefficient of determination. The accuracy and reliability of the virtual reality (VR) system were evaluated by comparison with existing studies and the required specs. Changes in motor control strategies due to the physio-avatar EB system were observed in four experiments, where the participants gradually returned to their pre-intervention control strategies. This result can be attributed to the aftereffects caused by error learning. This implies that the developed system influenced their motor control strategies. The number of EMG acquisition bits was 16 bits, and the sampling rate was 1,000 Hz. The refresh rate of the head-mounted display was 90 Hz, and its resolution was for a single eye. Additionally, the simulation frame rate was 30 FPS. These values were adequate compared to existing studies and required specs. The essential contribution of this study is the development of an avatar that is controlled by a different method than has been used in previous studies and the demonstration of changes in a subject's muscle activity after they experience an avatar. In the future, the clinical efficacy of the proposed system will be evaluated with actual patients.