Independent Observers Research Articles

Artificial intelligence-assisted volume isotropic simultaneous interleaved bright- and black-blood examination for brain metastases.

To verify the effectiveness of artificial intelligence-assisted volume isotropic simultaneous interleaved bright-/black-blood examination (AI-VISIBLE) for detecting brain metastases. This retrospective study was approved by our institutional review board and the requirement for written informed consent was waived. Forty patients were included: 20 patients with and without brain metastases each. Seven independent observers (three radiology residents and four neuroradiologists) participated in two reading sessions: in the first, brain metastases were detected using VISIBLE only; in the second, the results of the first session were comprehensively evaluated by adding AI-VISIBLE information. Sensitivity, diagnostic performance, and false positives/case were evaluated. Diagnostic performance was assessed using a figure-of-merit (FOM). Sensitivity and false positives/case were evaluated using McNemar and paired t-tests, respectively. The McNemar test revealed a significant difference between VISIBLE with/without AI information (P < 0.0001). Significantly higher sensitivity (94.9 ± 1.7% vs. 88.3 ± 5.1%, P = 0.0028) and FOM (0.983 ± 0.009 vs. 0.972 ± 0.013, P = 0.0063) were achieved using VISIBLE with AI information vs. without. No significant difference was observed in false positives/case with and without AI information (0.23 ± 0.19 vs. 0.18 ± 0.15, P = 0.250). AI-assisted results of radiology residents became comparable to results of neuroradiologists (sensitivity, FOM: 85.9 ± 3.4% vs. 90.0 ± 5.9%, 0.969 ± 0.016 vs. 0.974 ± 0.012 without AI information; 94.8 ± 1.3% vs. 95.0 ± 2.1%, 0.977 ± 0.010 vs. 0.988 ± 0.005 with AI information, respectively). AI-VISIBLE improved the sensitivity and performance for diagnosing brain metastases.

Axial rod slip at the end-of-construct screw in scoliosis surgery: relevance, occurrence and prevention

PurposeDespite standardized biomechanical tests for spinal implants, we recently recognized pedicle screw failure to maintain the rod fixated as a clinical concern in scoliosis surgery. This occurrence study investigates the risk and magnitude of axial rod slip (ARS), its relation with technique and preventive measures.MethodsRetrospective multicenter review of all primary scoliosis cases (2018–2020) with > 1 year FU from three centers, instrumented with uniplanar screws and 5.5 mm CoCr rods (Mesa 2, Stryker Corporation, Kalamazoo, MI, USA). ARS was defined as > 1 mm change in residual distal rod length from the screw in the lowest instrumented vertebra (LIV) and assessed by two independent observers. Slip distance, direction, relation to distal screw density and time of observation were recorded, as well as the effect of ARS on caudal curve increase. To prevent slip, more recent patients were instrumented with a different end-of-construct screw (Reline, NuVasive Inc. San Diego, CA, USA) and analyzed for comparison.ResultsARS risk was 27% (56/205) with a distance of 3.6 ± 2.2 mm, predominantly convex. 42% occurred before 4 months, the rest before 1 year. The caudal curve substantially increased three times more often in patients with ARS. Interobserver reliability was high and slip was in the expected direction. ARS was unrelated to distal screw density. Remarkable variation in ARS rates (53%, 31%, 13%) existed between the centers, while there was no difference in mean screw density (≈1.3 screws/level) or curve correction (≈60%). Revision surgery for ARS was required in 2.9% (6/207). Using the different end-of-construct screw, ARS risk was only 2% (1/56) and no revisions were required.ConclusionThis study demonstrates the prevalence of axial rod slip at the end of construct in scoliosis surgery and its clinical relevance. While minimal ARS can be subclinical, ARS should not be mistaken for adding on. The most severe ARS predominantly occurred convex at the high-loaded distal screw when L3 was the LIV. Longer constructs (LIV L3 or L4) have a higher risk of ARS. The minimal risk of ARS with another end-of-construct screw underscores the influence of screw type on ARS occurrence in our series. Further research is essential to refine techniques and enhance patient outcomes.

The effects of alfaxalone on cardiac and pulmonary vascular size in cats evaluated by thoracic radiography and echocardiography.

Alfaxalone is a neuroactive steroid that modulates the GABAA receptor, which has shown recent widespread use as a sedative and anesthetic agent in cats, especially in patients being screened for cardiovascular disease. This prospective, partially blinded, randomized experimental study aimed to determine if sedation with alfaxalone would alter the appearance of the cardiac silhouette or pulmonary vasculature on thoracic radiographs or echocardiographic indices of cardiac or pulmonary vascular size. Eleven apparently healthy adult cats were recruited from a research colony. Four-view thoracic radiographs and an echocardiogram were performed at baseline and following a 5mg/kg intramuscular dose of alfaxalone. Vertebral heart score (VHS) and cranial and caudal lobar pulmonary vascular measurements were obtained at both time points by two independent blinded observers, and these were analyzed using two-way ANOVA. The nonblinded echocardiographer obtained echocardiographic measurements at both time points, which were analyzed using a paired t-test or Wilcoxon signed rank test. No significant differences were identified in VHS measurements or echocardiographic parameters between baseline and sedated cats. In healthy cats, alfaxalone does not appear to significantly affect the cardiovascular structures evaluated via thoracic radiography or echocardiography.

Significant age-related differences between lower leg muscles of older and younger female subjects detected by ultrashort echo time magnetization transfer modeling.

Magnetization transfer (MT) magnetic resonance imaging (MRI) can be used to estimate the fraction of water and macromolecular proton pools in tissues. MT modeling paired with ultrashort echo time acquisition (UTE-MT modeling) has been proposed to improve the evaluation of the myotendinous junction and fibrosis in muscle tissues, which the latter increases with aging. This study aimed to determine if the UTE-MT modeling technique is sensitive to age-related changes in the skeletal muscles of the lower leg. Institutional review board approval was obtained, and all recruited subjects provided written informed consent. The legs of 31 healthy younger (28.1±6.1years old, BMI = 22.3±3.5) and 20 older (74.7±5.5years old, BMI = 26.7±5.9) female subjects were imaged using UTE sequences on a 3T MRI scanner. MT ratio (MTR), macromolecular fraction (MMF), macromolecular T2 (T2-MM), and water T2 (T2-W) were calculated using UTE-MT modeling for the anterior tibialis (ATM), posterior tibialis (PTM), soleus (SM), and combined lateral muscles. Results were compared between groups using the Wilcoxon rank sum test. Three independent observers selected regions of interest (ROIs) and processed UTE-MRI images separately, and the intraclass correlation coefficient (ICC) was calculated for a reproducibility study. Significantly lower mean MTR and MMF values were present in the older compared with the younger group in all studied lower leg muscles. T2-MM showed significantly lower values in the older group only for PTM and SM muscles. In contrast, T2-W showed significantly higher values in the older group. The age-related differences were more pronounced for MMF (-17 to -19%) and T2-W (+20 to 47%) measurements in all muscle groups compared with other investigated MR measures. ICCs were higher than 0.93, indicating excellent consistency between the ROI selection and MRI measurements of independent readers. As demonstrated by significant differences between younger and older groups, this research emphasizes the potential of UTE-MT MRI techniques in evaluating age-related skeletal muscle changes.

Factors influencing the reliability of measurements in eyes with full-thickness macular holes: are we measuring incorrectly?

PurposeThe calliper function is used for manual measurements of full thickness macular holes (FTMHs). We aimed to investigate whether a reproducible difference could be detected beyond interobserver variability between two...

Hypertrophy Determination of H9c2 Cardiomyoblast Cell Line Using Wright-Giemsa Staining: An Experience in Developing an Acceptable and Easy-to-handle In-vitro Protocol

Introduction Cell-size area (CSA) becomes the standard parameter routinely tested in vitro for cardiac hypertrophy studies. Thus, staining is an essential tool for this purpose. As reported in a previous study, immunofluorescence staining is an established method for CSA. However, because it is expensive and requires a specialized microscope, e.g., immunofluorescence or confocal microscope, it is not applicable in a laboratory with limited equipment. Wright-Giemsa staining is a standard procedure in hematology laboratories and is inexpensive and convenient. Here, we shared our experience developing a CSA determination protocol using Wright-Giemsa in H9c2 cardiomyoblast. Methods The viability tests were performed on H9c2 to determine the effective dosage of angiotensin II and Irbesartan (standard drug). The H9c2 were divided into three groups: the control group (without either angiotensin II or irbesartan), the negative control (with angiotensin II), and the positive control (with angiotensin II and Irbesartan), triplicate for each group. The cells then are acclimatized overnight, serum-starved for one day, and incubated with angiotensin and irbesartan for 48 hours. Lastly, Wright-Giemsa was observed using a light microscope in three fields. The CSA was determined by three independent observers blindly, statistically different if the p&lt;0.05 using ANOVA ways or Kruskal-Wallis. Results After the H9c2 induced by angiotensin-II 1 μM and Irbesartan 1μM, we found the CSA significantly differed among each group (p&lt;0,0001). The negative control has a higher median and interquartile range (IQR) CSA (10.78 (6.79) um2) compared to the control group (median (IQR) 7.27 (4.91) um2) and positive control (median (IQR) 7.849(5.31) um2). Conclusion It can be concluded that the Wright-Giemsa might help determine the CSA for in-vitro hypertrophic studies.

Effectiveness of the Practice of Standardized Handover Process Using a Checklist in the Postanesthesia Care Unit: An Observational Study.

Patient handovers without any structured checklist may omit essential information that might have undesirable consequences for patients. We sought to determine the effectiveness of a structured postanesthesia care handover (PACH) checklist in the postanesthesia care unit (PACU) to reduce adverse clinical outcomes. A single-center, prospective, pre-postimplementation study was conducted. Moreover, post-PACH checklist implementation data were collected from 130 participants ( n = 65 in each group) by an independent observer. Data analysis was performed using the SPSS (25.0) version (IBM SPSS statistics). The Chi-square test was used to compare the dichotomous response. A statistically significant reduction in hypoxemia (21.5% vs. 0; P < 0.001) was observed in the postimplementation group. There were significant improvements in patient information ( P < 0.01), reduction in variations in hemodynamic parameters ( P < 0.01), and improvement in the quality of information transferred concerning surgical procedures ( P < 0.01). The number of phone calls to consultants was significantly lower in the PACH group. Implementation of the PACH checklist was associated with no hypoxemic events in PACU by improving the quality of communication. The implementation of a structured checklist in PACU should be mandatory in the postoperative intensive care unit.

Evaluating Postoperative Pain Management using the Detroit Interventional Pain Management tool after fracture surgery: How well are we really doing?

To assess patients' opioid prescription usage and pain management satisfaction after fracture surgery. Design : An IRB-approved prospective prognostic cohort study for postoperative fracture patients was conducted. Patients were evaluated by an independent observer at two weeks, six weeks, three months, and six months postoperatively where they were given Detroit Interventional Pain Assessment (DIPA) questionnaires regarding their postoperative pain and opioid usage. Opioid prescriptions were verified by Michigan Automated Prescription System. All patients were divided into major fractures (tibia, femur, acetabulum, pelvis, calcaneus, talus, and polytrauma) and minor fractures (scapula, clavicle, humerus, radius, ulna, scaphoid, carpal/metacarpal, patella, fibula, ankle, and metarsal) and were followed for two years. Single-Center Level One Trauma Center. Patients presenting to clinic over a six month period were invited to participate in this study. Patients who did not consent were excluded. Outcome measures were the amount of prescribed opioids in daily Milligram Morphine equivalents (MMEs), opioid usage, DIPA pain scores, pain management efficiency (percentage of patients reporting no pain or tolerable pain with their regimen). Prescribed MMEs, pain management efficiency scores, and the percentage of patients using opioids were compared across all postoperative periods. For 201 fracture patients, the average age was 47.8 ± 16.3 SD (18-87 years) and there were 116 males (57.8%) and 85 females (42.2%). The percentage of patients using opioids and their daily prescribed MMEs significantly decreased from two weeks (48.2%, 21.6 MMEs) to six months (10.3%, 8.13 MMEs) (P < 0.001). Fifty-one percent of patients were off opioids at two weeks, 64.5% at six weeks, 84.2% at three months, and 89.7% at six months. All opioid prescriptions at six months and two years were prescribed to polytrauma patients who underwent sequential surgeries and these prescriptions originated from outside prescribers. Pain management efficiency scores were worst at two weeks (67.2%) but improved at three months (82.6%). As patients transitioned further from their surgical date, there was a decrease in opioid prescriptions and patient reported opioid usage. Despite the opioid tapering practices by surgeons, polytrauma patients still received prescriptions from outside prescribers for orthopaedic aftercare after three months, signaling the necessity for patients to see outside prescribers for their pain management after this time. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Novel Method to Measure Volumes of Retinal Specific Entities.

Objectives: The aim of this study is to describe and validate an optical-coherence-tomography (OCT)-based method to easily calculate specific volumes, addressing the limitations of current OCT software in automating volumetric analysis for specific entities in retinal pathologies. Methods: After manually drawing the specific entity on linear OCT scans using the calliper function and automated measurement of its area, the following formula was used for volumetric calculation: Volume [mm3] = ∑area [mm2] × OCT-scan distance [mm]. Retinal volume (RV) was measured by two independent observers in eyes with a normal foveal profile (NFP) and was compared with the automated measurements performed by the OCT software (Engineering GmbH, Heidelberg, Germany); the same process was repeated for the volume of the foveal cavity (FC) or foveoschisis (FS) in eyes with lamellar macular holes (LMHs). Power calculations were conducted to ensure adequate sample size. The measurements were re-acquired after six weeks. Intra- and inter-observer variability as well as comparison to automated RV calculations were analysed. Results: This study included a total of 62 eyes divided into two groups: the NFP (30 eyes) and LMH (32 eyes) groups. The Bland-Altman plots showed a high degree of agreement in both groups for inter-observer and intra-observer agreement. In addition, in the NFP group, a high degree of agreement was demonstrated between human observers and the OCT software (Spectralis). Conclusions: An easy, reliable, and widely applicable method to calculate volumes is described and validated in this paper, showing excellent inter- and intra-observer agreement, which can be applied to any entity requiring a specific study in the context of retinal pathologies.

Posterior Cruciate Buckling Angle Variations Are Associated with Different Patterns of Medial Meniscus Tears in Anterior-Cruciate-Deficient Knees: Results of a Prospective Comparative Magnetic Imaging Resonance Study.

The diagnosis of anterior cruciate ligament (ACL) tear relies on clinical evaluation and magnetic resonance imaging (MRI). Direct and indirect signs of ACL tear have been described with MRI evaluation. Posterior cruciate ligament (PCL) buckling has been described as an indirect radiographic sign of an ACL tear. The aim of the present study was to assess the variations in PCL buckling angles in patients with ACL tears and in patients with isolated lesions in the posterior horn of the medial meniscus. In addition, the influence of different patterns of medial meniscus tears in ACL-deficient knees was investigated. Finally, the influences of risk factors such as tibial slope, delay from injury to surgery, absence of medial meniscus tear, degree of Lachman and pivot shift testing were also assessed. This was a cohort study. A total of 154 patients (78 in the group with ACL tear and 76 in the control group) were assessed with MRI and lateral weight-bearing X-ray to assess PCL buckling angle and tibial slope by two independent observers. The presence of a medial meniscus bucket handle or ramp lesion of the medial meniscus was assessed and recorded at the time of surgery. PCL buckling angle measurement was highly reliable, with an ICC of 0.866 and 0.894, respectively, in the study group and the control group for interobserver reliability. The intrarater reliability was found to be high in PCL buckling angle for the study group [ICC = 0.955] and the control group [ICC = 0.943]. The mean angle in patients with ACL tear was 110.7 ± 15.2° and 115.3 ± 16.2° (for the two examiners) and 111.4 ± 12° and 114 ± 14.5° (for the two examiners) in patients with an intact, healthy ACL. An association emerged between bucket handle tears of the medial meniscus (p = 0.010) and a decreased PCL buckling angle and between ramp lesions of the medial meniscus and increased PCL buckling angle both (p = 0.024). Good inter- and intraobserver reliability for the measurement of the PCL buckling angle was observed. Increased PCL buckling angle values were observed in patients with concomitant ACL and bucket handle tears of the medial meniscus, while decreased angle values were observed in those who had ACL tear and ramp lesion of the medial meniscus. No statistically significant difference in the PCL buckling angle emerged between patients with ACL tears and those who had a healthy, intact ACL.

Advancing Ki67 hotspot detection in breast cancer: acomparative analysis of automated digital image analysis algorithms.

Manual detection and scoring of Ki67 hotspots is difficult and prone to variability, limiting its clinical utility. Automated hotspot detection and scoring by digital image analysis (DIA) could improve the assessment of the Ki67 hotspot proliferation index (PI). This study compared the clinical performance of Ki67 hotspot detection and scoring DIA algorithms based on virtual dual staining (VDS) and deep learning (DL) with manual Ki67 hotspot PI assessment. Tissue sections of 135 consecutive invasive breast carcinomas were immunohistochemically stained for Ki67. Two DIA algorithms, based on VDS and DL, automatically determined the Ki67 hotspot PI. For manual assessment; two independent observers detected hotspots and calculated scores using a validated scoring protocol. Automated hotspot detection and assessment by VDS and DL could be performed in 73% and 100% of the cases, respectively. Automated hotspot detection by VDS and DL led to higher Ki67 hotspot PIs (mean 39.6% and 38.3%, respectively) compared to manual consensus Ki67 PIs (mean 28.8%). Comparing manual consensus Ki67 PIs with VDS Ki67 PIs revealed substantial correlation (r = 0.90), while manual consensus versus DL Ki67 PIs demonstrated high correlation (r = 0.95). Automated Ki67 hotspot detection and analysis correlated strongly with manual Ki67 assessment and provided higher PIs compared to manual assessment. The DL-based algorithm outperformed the VDS-based algorithm in clinical applicability, because it did not depend on virtual alignment of slides and correlated stronger with manual scores. Use of a DL-based algorithm may allow clearer Ki67 PI cutoff values, thereby improving the clinical usability of Ki67.

Increased glenoid baseplate retroversion improves internal rotation following reverse shoulder arthroplasty

BackgroundInternal rotation after reverse shoulder arthroplasty (RSA) is often unchanged or minimally improved. The primary purpose of this study was to investigate the effects of glenoid baseplate version on postoperative internal rotation. The secondary purpose to investigate the effects of baseplate retroversion on external rotation (ER) and patients reported outcomes (PROs). MethodsA retrospective review was performed on a prospectively maintained multicenter database of patients who underwent primary RSA using a 135° humeral prosthesis and lateralized glenoid with minimum 2-year clinical follow-up. Preoperative and postoperative radiographs were reviewed by two independent observers who assessed preoperative glenoid version and postoperative glenoid baseplate version. Patients were stratified by postoperative retroversion (<10°, 10-19° or >20°) and change in version from preoperative to postoperative (ΔRV). Primary outcomes were internal rotation with the arm at 90° (IR90) and internal rotation estimated to nearest spinal level (IRspine). Secondary outcomes were active external rotation in adduction (ER0), active external rotation with arm at 90° (ER90), forward flexion (FF), and PROs. Linear regression analyses and one-way analysis of variance (ANOVA) analyses were used for comparisons. Results274 patients with a mean of 71 years of age were included in the study. Patients with >10° of postoperative baseplate retroversion gained 20° of IR90 (p=0.005) without loss of ER90 (p<0.001) compared to patients with <10° of baseplate retroversion. More than 10° of postoperative baseplate retroversion was associated with significantly improved Constant-Murley scores (41.5, p=0.007) and SANE scores (45.4, p=0.047) compared to patients with less than <10° of baseplate retroversion. Patients with a ΔRV increase of > 10° had significantly improved IR90 (p=0.031) without loss of ER90 (p=0.019). There was no correlation between ΔRV and IRspine, ER0 or FF, or PROs. ConclusionWith a 135° and lateralized glenoid, postoperative baseplate retroversion of >10° was associated with significantly improved IR90, ER90, Constant-Murley and SANE scores at 2 years follow-up compared to <10° retroversion. Additionally an increased ΔRV from pre- to postoperative appears to improve IR90 without limiting ER0 or FF. While baseplate retroversion does not improve IRspine, overall function appears to be improved and therefore consideration may be given to accepting retroversion or intentionally retroverting the baseplate if fixation allows.

Surgical Innovation: Comparative Efficacy of Navigation-Assisted Modified Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF) and Traditional MIS-TLIF in Treating Low-Grade Isthmic Spondylolisthesis in the Elderly

To compare the efficacy of navigation-assisted modified MIS-TLIF (Minimally invasive transforaminal lumbar interbody fusion) and MIS-TILF in the treatment of low-grade isthmic spondylolisthesis in the elderly. We retrospectively included elderly patients with low-grade isthmic spondylolisthesis who underwent surgical treatment at our hospital from January 2019 to January 2022. Based on the surgical method chosen according to the patient's personal preference, the patients were divided into the modified MIS-TLIF group and the MIS-TLIF group. The modified MIS-TLIF group underwent navigation-assisted MIS-TLIF, while the MIS-TLIF group underwent conventional MIS-TLIF. A total of 54 patients (34 males and 20 females) were included in this study, with 26 cases in the modified MIS-TLIF group and 28 cases in the MIS-TLIF group. Relevant data for this study were collected by an independent observer. The demographic characteristics, including age, gender, BMI, comorbidities, surgical level, Meyerding grade, and duration of symptoms before admission, were recorded and compared between the two groups. Perioperative parameters, such as operative time, intraoperative blood loss, postoperative drainage volume, bed rest time, and hospital stay, were also recorded and compared. The lumbar pain visual analog scale (BP-VAS), Oswestry Disability Index (ODI), and lumbar JOA scores were recorded preoperatively and at 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively to evaluate functional recovery in both groups. At 12 months postoperatively, patient satisfaction was assessed using the Macnab criteria (with satisfaction defined as the number of excellent and good outcomes divided by the total number in the group × 100%). The rate of vertebral slippage was recorded preoperatively, at 1 week postoperatively, and at 12 months postoperatively. The accuracy of screw placement was evaluated by CT scan at 1 week postoperatively, and interbody fusion was assessed by CT scan at 12 months postoperatively. Surgical complications were recorded, and their incidence was calculated. The intraoperative blood loss, postoperative drainage volume, bed rest time and hospital stay in the modified MIS-TLIF group were less than those in the MIS-TLIF group (P< 0.05). The BP-VAS (Back Pain Visual Analogue Scale), ODI (Oswestry Disability Index), and JOA (Japanese Orthopaedic Association) modified MIS-TLIF groups improved significantly compared with the MIS-TLIF group at 1 week, 1 month, 3 months, and 6 months after surgery, and the differences between groups were statistically significant (P<0.05). The excellent and good rate of modified MIS-TLIF group was higher than that of MIS-TLIF group, and the difference had statistical significance (P<0.05). The accuracy of screw placement in the modified MIS-TLIF group was higher than that in the MIS-TLIF group, and the difference was statistically significant (P<0.05). The fusion rate in the modified MIS-TLIF group was higher than that in the MIS-TLIF group at 12 months after surgery, and the difference was statistically significant (P<0.05). No statistical difference in the incidence rate of complications between the two groups. Compared with MIS-TLIF, navigation-assisted modified MIS-TLIF has the advantages of less trauma, rapid recovery, accurate screw placement, high fusion rate, high surgical satisfaction and good safety.

Identifying Lower Extremity Deformities in the Coronal Plane: Lessons From Remote Learning During the COVID-19 Pandemic.

Introduction During the COVID-19 pandemic, the AO Foundation, an orthopedic education organization, had to transition its live education programs to an online format. Skills that were previously evaluated and corrected in person by educators were now assessed through online lectures and discussion groups. Our goal was to evaluate an online course designed to teach the skill of "leg length and coronal deformity measurement" and to assess participants' ability to demonstrate this skill using online software. Methods An IRB-approved study was conducted during an online osteotomy course. A total of 176 participants were instructed on how to measure length and angulation through the course lectures and planning tutorials. The Bonesetter App (Detroit Bonesetter, Detroit, Michigan, USA) was used as the digital planning tool. Participants analyzed four cases of coronal deformity using long-leg standing radiographs. They were required to identify any deformities present, specify the type of deformity, and determine whether it affected the femur, tibia, or joint. Additionally, participants needed to calculate the deformity as part of the osteotomy planning process. Their measurements and drawings were saved and subsequently evaluated by two independent observers. Results Out of 176 online participants, 76% (315 out of 417) correctly completed the four exercises. The most frequent errors occurred in measuring total deformity and joint deformity. The average standard deviation of length measurements was ±0.29 cm (based on 244 measurements), while for angular measurements, it was ±0.71 degrees (based on 688 measurements). The intraclass correlation coefficient was greater than 0.96. Conclusions The online course effectively taught coronal deformity measurement, although participants struggled most with measuring joint angles and total deformity. Future courses should provide more detailed explanations for these measurements.

What is the minimal perceptible change for the dimensional alteration of facial structures in the frontal view?

BackgroundA better understanding of the perceptibility of dimensional changes in facial structures is of interest to all involved in facial esthetics. PurposeWe aimed to determine the minimal perceptible change (MPC) in the dimensional alterations of the facial structures in the frontal view and the influential factors. Study design, setting, sampleThis cross-sectional study was conducted on individuals accompanying the patients at the outpatient department of a tertiary care hospital and students in art and science. Those with impaired cognition, craniofacial anomalies, history of esthetic facial surgeries and health professionals working on facial esthetics were excluded. Independent variablesThe observers assessed the frontal photographs of two models and their modifications. The independent variables were the anatomic structure modified (mouth, nose, ears, eyes), the percentage change (5, 10, 15%), and the type of modification (magnification or reduction). Outcome VariablesThe outcome variables were the MPC (perceived by at least 50% of the observers) and the perceptibility of changes (Yes/No) CovariatesThe age of the observer, the sex of the observer and the model were the covariates. AnalysisThe inter-group differences in perceptibility of changes and the influence of independent variables and covariates were analyzed with Chi-square / Cochran's Q test and generalized estimating equations, respectively, with statistical significance set at p<.05. ResultsThe sample comprised 110 males and 110 females, aged 23.9 ± 5.8 years. The MPC was 5% for the mouth, nose, and eyes and 15% for the ears. The changes in the nose [OR=0.68(0.56-0.83), p<.001], ears [OR=0.29(0.24-0.36), p<.001], and eyes [OR=0.78(0.64-0.95), p=.015] were less perceptible than the mouth. The perceptibility was higher in female than male observers [OR= 1.37(1.11-1.69), p=.003] and reduction than magnification [OR=1.11(1.00-1.23) p=.036]. Compared to a 5% change, the perceptibility was higher for 10 and 15% [OR= 2.00(1.76-2.27), 3.33(2.84-3.91), respectively, p<.001]. Conclusions and RelevanceThe MPC was 5% for the mouth, nose, and eyes and 15% for the ears. The perceptibility of change was influenced by the structure, the extent and type of modification and the observer's sex. These findings may be of use to all professionals involved in esthetic facial corrections.

Radio continuum emission from planetary nebulae in the Small Magellanic Cloud

We report 11 new radio continuum measurements of established planetary nebulae (PNe) in the Small Magellanic Cloud (SMC) that we observed at 5.5 and 9 GHz with the Australia Telescope Compact Array (ATCA). These new radio detections are PNe with catalogued names: SMP SMC 2, SMP SMC 3, SMP SMC 5, SMP SMC 8, SMP SMC 13, SMP SMC 14, SMP SMC 19, MGPN SMC 8, SMP SMC 22, SMP SMC 26 and SMP SMC 27. We supplement our data with available high-resolution radio observations from MeerKAT and construct the spectral energy distribution (SED) in the radio regime for each PN. We determine the angular diameters of four of the eleven PNe from radio flux density alone using SED modelling, which are compared to the corresponding Hubble Space Telescope (HST) optical diameters. Our results are in good agreement with the optically-derived angular diameters from independent HST observations. We plot our new diameter estimates against a larger sample of Galactic PNe and compare diameters obtained via the SED method to those found in the literature. Our sample diameters, when compared to the Galactic PNe, suggest that the angular diameter measurement methods are comparable independent of the distance.

Wind-line Variability and Intrinsic Errors in Observational Mass-loss Rates

UV wind-line variability in OB stars appears to be universal. In order to quantify this variation and to estimate its effect on a mass-loss rate determined from a single observation, we use the International Ultraviolet Explorer archive to identify nonpeculiar OB stars with well-developed but unsaturated Si iv λ1400 doublets and at least 10 independent observations. This resulted in 1699 spectra of 25 stars. A simple model was used to translate the observed profile variations into optical depth variations and, hence, variations in measured mass-loss rates. These variations quantify the intrinsic error inherent in any single mass-loss rate derived from a single observation. The derived rates have an overall 1σ variation of about 22%, but this appears to differ with T eff, being as small at 8% for the hottest stars and up to 45% for the cooler ones. Furthermore, any single determination can differ from the mean by a factor of 2 or more. Our results also imply that mass-loss rates determined from nonsimultaneous observations (such as UV and ground-based data) need not agree. In addition, we use our results to examine the nature of the structures responsible for the variability. Our findings suggest that the optical depth variations result from optically very thick structures occulting more or less of the line of sight to the stellar disk. Further, the smaller optical depth variations in the hottest stars suggest that the structures responsible for the variations are disrupted in their more powerful winds.

Superobbing and Thinning Scales for All-Sky Humidity Sounder Assimilation

Abstract Humidity sounder radiances are currently thinned to 110-km spacing prior to assimilation at ECMWF and used with no averaging applied. In this paper, the thinning scale and possible averaging of all-sky humidity sounder observations into “superobs” are considered. The short- and medium-range forecast impacts of changing the thinning and averaging scales of humidity sounder radiances prior to the data assimilation are investigated separately and then together. Superobbing acts as a low-pass filter and provides smoother images of departures, decreasing the effective sensor noise and thus the standard deviation of background departures, marginally for 183-GHz channels (5%–15%) and significantly for 118-GHz channels (5%–55%). Observations are thus more representative of the model effective resolution, with a better utilization of total information content than thinning native-resolution radiances, as less information is discarded. Whether changed in isolation or combination, the additions of data via superobbing and finer thinning are both shown to markedly improve background fits to independent observations, indicative of better short-range forecasts of humidity and improved winds via the 4D-Var tracer effect. Wind forecasts in the Southern Hemisphere are slightly improved in the medium range. A final configuration is tested at the resolution of the current operational model, with humidity sounder radiances averaged into 50-km superobs with 70-km spacing. This provides about 140% more radiances for assimilation and more finely detailed maps to analyze mesoscale features. The forecast impact of this change is larger in testing with higher model and data assimilation resolutions, showing the scale dependence of such decisions and the expected performance in an operational configuration. Significance Statement This paper investigates thinning and averaging scales for humidity-sounding microwave observations in the ECMWF data assimilation system. The introduction of spatial averaging shows a positive impact, as does the assimilation of observations with finer spacing. These changes permit more total information on humidity into the system, and both are beneficial for short-range forecasts of humidity and winds in the mid- to upper troposphere. The results highlight the interplay between spatial scales of observations and those of the analysis system, with possibilities for improved utilization in this particular case. This is expected to remain a key consideration in assimilation systems going forward, given the continued increases in the resolution of assimilation systems and forecast models.

Grief among parents of children with autism spectrum disorders: a systematic review

Objectives Bringing up a youngster with Autism Spectrum Disorders (ASD) is a multifaceted issue with major changes in family dynamics. Parents experience great distress and feel anxious or sad throughout the diagnostic process and the time after the diagnosis. There are very few studies on the aspect of grief in parents of children with ASD. Hence an attempt was made to do a systematic review of the available literature to assess the prevalence and pattern of grief among parents of children with autism spectrum disorder. Methods A systematic review of available literature was done up to November 2021. The data was extracted from the literature by two independent observers and any conflict was resolved by a third person. Results The two predominant disorders seen in these parents are grief and distress. The emotions usually described are the sense of loss leading to pain, parental expectations being put into peril, shock, turmoil, and a feeling of helplessness in family members after hearing the diagnosis. Conclusions A literature search has revealed a huge lacuna in studies related to the feelings of grief experienced by the caregivers of autistic children. Emotional stability and coping of the parents are highly essential not only for the rehabilitation of the child but also to make an improvement in the quality of life of the parents. The primary caregivers of children in the spectrum suffer very powerful and incessant emotions of sadness and grief. The feelings of mothers and fathers of children with autism from recent studies include an unexpected sense of losing a child along with shock, denial, fearfulness, guilt, rage, and/or sorrow. Two most common affective reactions of these parents were grief (“chronic sorrow” or “nonfinite grief”) and distress. The maternal experience of grief was found to be more especially in children with recent diagnoses of autism.

140-year daily ensemble streamflow reconstructions over 661 catchments in France

Abstract. The recent development of FYRE (French hYdroclimate REanalysis) Climate, a high-resolution ensemble daily reanalysis of precipitation and temperature covering the 1871–2012 period and the whole of France, offers the opportunity to derive streamflow series over the country from 1871 onwards. The FYRE Climate dataset has been used as input for hydrological modelling over a large sample of 661 near-natural French catchments using the GR6J (Génie Rural à 6 Paramètres Journaliers) lumped conceptual model. This approach led to the creation of the 25-member hydrological reconstructions, HydRE (Hydrological REconstruction), spanning the 1871–2012 period. Two sources of uncertainties have been taken into account: (1) the climate uncertainty using forcings from all 25 ensemble members provided by FYRE Climate and (2) the streamflow measurement error by perturbing observations used during the calibration. Further, the hydrological model error based on the relative discrepancies between observed and simulated streamflow has been added to derive the HydREM (Hydrological REconstruction with Model error) streamflow reconstructions. These two reconstructions are compared to other hydrological reconstructions with different meteorological inputs, hydrological reconstructions from a machine learning algorithm, and independent and dependent observations. Overall, the results show the added value of the HydRE and HydREM reconstructions in terms of quality, uncertainty estimation, and representation of extremes, therefore allowing us to better understand the variability in past hydrology over France.