Fixation Location Research Articles

Orienting to and away from the eyes in infants at high likelihood for autism when scanning faces.

This study employed eye-tracking technology to investigate the mechanisms underlying reduced gaze towards the eyes in infants at high likelihood (HL) for autism, specifically examining whether it results from avoidance triggered by heightened arousal when looking at the eyes or due to indifference to the eyes (i.e., unwilling to orient to the eyes). Infants at HL for autism and typically developing (TD) infants aged within 24 months were tested. In the experiment, participants' gaze was initially guided to the eye or mouth region immediately before the onset of the face. Latency to orient away from the guided regions, latency to orient to the eyes, and the location of the secondary fixation following the onset of the face were measured. The results showed that: (1) The HL infants looked less at eyes than TD infants; (2) Compared with TD infants, HL infants oriented towards eyes more slowly after being guided to the mouth; (3) After being guided to the eyes, HL infants' secondary fixation fell less in the eye region, and their latency to orient away from the eyes was also tended to be shorter. These results suggest that reduced eye-looking time was presented in HL infants, which was further explained by both eye avoidance and indifference to the eyes. Our study contributes theoretically to understanding the atypical face scanning pattern in autistic people and its related underlying mechanisms. Furthermore, our study provides important insights into the development of early screening tools and intervention protocols for autistic people.

Eye movements of children with and without developmental dyslexia in an alphabetic script during alphabetic and logographic tasks

Eye movements (EM) during naming alphabetic versus logographic stimuli in children with and without developmental dyslexia (DD) were examined for each stimulus separately to identify conspicuous characteristics that influence naming performance. 40 children (group DD = 18; control group C = 22) were taught Chinese characters. EM were recorded during naming alphabetic words, pictures and Chinese characters. Main variables were articulation latencies, numbers and durations of fixations, secondary variables were fixation locations and error rates. Group DD showed significantly longer latencies and more fixations while reading words, but only insignificantly more fixations while naming pictures and Chinese characters. However, their error rate was significantly higher during naming Chinese characters but correlated neither with severity of phonological deficit nor with visual complexity. Their first fixation was significantly more often on the center of characters, in group C on the left. In both groups, EM variables were influenced by conspicuous features of characters, such as visual complexity, composition and structure. EM variables and scanning behavior while naming Chinese characters indicate holistic processing in the visuo-spatial pathway and were affected by conspicuous features of characters. The higher error rate in group DD could be determined by several factors, without a major role of the phonological deficit.

Stay focused! Exploring the compulsive nature of alcohol-related attentional bias in severe alcohol use disorder.

Prominent models postulate that alcohol-related attentional bias (AB), emerging from the overactivation of the reward system, plays a key role in severe alcohol use disorder (sAUD) and is independent from voluntary control. We determined whether AB is indeed compulsive or can be modulated by the control/inhibition system. Patients with sAUD (17 women, 13 men, mean age of 47, White) and matched healthy controls (16 women, 14 men, mean age of 44, White) performed a visual probe task with behavioral (reaction time) and eye-tracking (first fixation location and duration, second fixation location, dwell time) measures. They also performed an avoidance task, requiring to focus on a target by voluntarily inhibiting eye movements toward alcohol/nonalcohol/nonappetitive distractors and measuring overt (break frequency) and covert (fixational eye movements) attentional processes. Patients with sAUD exhibited an avoidance AB indexed by (a) reduced attentional resources dedicated to alcohol-related stimuli, namely, reduced dwell time (p = .040) and second fixation (p = .001) toward these stimuli; (b) increased inhibitory processes, namely, easier inhibition of saccades toward alcohol measured by lower break frequency (p < .001); and (c) covert eye movements posited further away from alcohol. In contradiction with theoretical models, our two tasks did not show any AB toward alcohol in sAUD. Instead, patients exhibited an avoidance AB indexed by increased inhibitory processes as well as reduced overt and covert attentional resources dedicated to alcohol-related stimuli. These results question the theoretical and clinical role of AB, as measured through reliable eye-tracking tasks, in sAUD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Effect of Fixation Location on Face Perception in Younger and Older Adults

The Effect of Fixation Location on Face Perception in Younger and Older Adults

An egocentric video and eye-tracking dataset for visual search in convenience stores

We introduce an egocentric video and eye-tracking dataset, comprised of 108 first-person videos of 36 shoppers searching for three different products (orange juice, KitKat chocolate bars, and canned tuna) in a convenience store, along with the frame-centered eye fixation locations for each video frame. The dataset also includes demographic information about each participant in the form of an 11-question survey. The paper describes two applications using the dataset — an analysis of eye fixations during search in the store, and a training of a clustered saliency model for predicting saliency of viewers engaged in product search in the store. The fixation analysis shows that fixation duration statistics are very similar to those found in image and video viewing, suggesting that similar visual processing is employed during search in 3D environments and during viewing of imagery on computer screens. A clustering technique was applied to the questionnaire data, which resulted in two clusters being detected. Based on these clusters, personalized saliency prediction models were trained on the store fixation data, which provided improved performance in prediction saliency on the store video data compared to state-of-the art universal saliency prediction methods.

Fixation of the rotator cuff tendons for the greater tuberosity fracture of the humerus

Introduction Strategical approaches to managing patients with a greater tuberosity fracture of the humerus are controversial and there are discussions about surgical treatment options. Nondisplaced fractures require no surgical management. Shoulder replacement can be indicated for the surgical treatment of proximal humeral fractures with limited function of the upper limb and difficulties in refixation of the rotator cuff tendons due to the peculiar anatomical location of the tendon fixation. Solution to this problem can improve the quality of life of patients with greater tuberosity fracture of the humerus.The objective was to evaluate the treatment outcome of a patient with a greater tuberosity fracture of the humerus repaired with open refixation of the rotator cuff tendons and medialization of the border of the articular surface of the humerus.Material and methods A 46-year-old patient presented with limited movements and severe pain in the left shoulder after humerus dislocation and a greater tuberosity fracture.Results The condition was repaired with an open repair of the rotator cuff tendons and medialization of the border of the articular surface of the humerus. The patient reported neither pain nor limited movements in the left shoulder at the one-year follow-up.Discussion Treatment options for patients with a greater tuberosity injury remains controversial. The effectiveness and results of organ-saving surgery have not been explored and require scientific evaluation using a larger cohort of patients.Conclusion Excellent functional results were achieved in a patient with injury to the greater tuberosity using surgical refixation of the rotator cuff tendons and medialization of the cartilaginous surface.

No such thing as the female eye: ditching gender-binary categories in art perception

ABSTRACT We still know little about whether and how gender informs, shapes, or influences art perception. This multidisciplinary article investigates the role that gender might play in the perception of art through historical analyses and an eye-tracking experiment. We first traced how gender identity, sexual identity, and sexual orientation have been used to theorize the existence of a gender-binary difference between viewers in traditional aesthetics and feminist art theory. To test whether such claims reflect any measurable experience, we collected eye-tracking data from 84 participants and divided them into two groups of cisgender, heterosexual individuals by self-definition. Each group participated in two experiments; the first showed digital reproductions of mixed artworks, varying in subject, style, form, and size; the second showed artworks with only one figure, either explicitly showing sex-linked traits or not. In both cases, we measured the number of fixations, average fixation duration, and saccade amplitude as well as differences in the location of fixations and entropy. Our analysis did not detect any significant difference between the groups. This proves empirically, for the first time, that in spite of having been often reiterated in history, gender binary categories are not suitable for describing the visual perception of art.

Superior capsular reconstruction using the long head of biceps tendon: a biomechanical assessment of tenodesis location and angle of fixation

BackgroundMassive irreparable rotator cuff tears (MIRCT) treated with superior capsular reconstruction (SCR) using the long head of the biceps tendon have shown satisfactory early results. Different techniques and positions for biceps tenodesis have been described. This study aimed to evaluate the effect of tenodesis location and glenohumeral fixation angle for graft tensioning on the biomechanics of a SCR using a single strand biceps technique. MethodsEight cadaveric shoulders were mounted to a custom biomechanical simulator which employed static tone loads to the deltoid and rotator cuff muscles. All cadavers were first tested in the intact condition, and then in the simulated MIRCT condition by sectioning the tendinous insertions of the supraspinatus and upper border of the infraspinatus. SCR using the long head of the biceps tendon was then evaluated. Three biceps tenodesis locations relative to the greater tuberosity (anterior, middle, and posterior) and two glenohumeral fixation angles (0° and 30°) for graft tensioning were tested. An optical tracking system was used to quantify superior-inferior (SI) and anterior-posterior (AP) humeral head translation relative to the glenoid, while the functional abduction force was quantified using a load sensor. All tests were conducted at 0°, 30° and 60° of glenohumeral abduction in a randomized fashion. ResultsWhen assessing isolated superior humeral head migration, all biceps tenodesis locations were effective at decreasing superior migration, with no tenodesis location significantly better than the other (P=0.213). However, biceps grafts tensioned at 30° of glenohumeral abduction were significantly better at reducing proximal humeral migration as compared to graft tensioning at 0° abduction (P=0.008).Posterior humeral head translation observed in the MIRCT condition was significantly reduced when tensioning the biceps tendon at 30° of glenohumeral abduction compared to 0° for all tenodesis locations (P≤0.043). Tenodesis location also significantly influenced posterior humeral head translation (P=0.001), with middle and posterior positions restoring near normal humeral head position when fixed at 30° glenohumeral abduction. All SCR techniques using the biceps tendon improved the functional abduction force relative to the MIRCT condition, although no statistically significant differences were observed relative to the intact condition (P≥0.448). DiscussionSCR using the long head biceps tendon is biomechanically effective in reducing posterosuperior translation of the humeral head in the setting of a MIRCT. Graft tensioning and fixation at 30° of glenohumeral abduction combined with either a middle or posterior tenodesis location on the greater tuberosity most effectively restores near normal time-zero humeral head kinematics.

Effects of Inversion and Fixation Location on the Processing of Face and House Stimuli - A Mass Univariate Analysis.

Most Event Related Potential studies investigating the time course of visual processing have focused mainly on the N170 component. Stimulus orientation affects the N170 amplitude for faces but not for objects, a finding interpreted as reflecting holistic/configural processing for faces and featural processing for objects. Furthermore, while recent studies suggest where on the face people fixate impacts the N170, fixation location effects have not been investigated in objects. A data-driven mass univariate analysis (all time points and electrodes) was used to investigate the time course of inversion and fixation location effects on the neural processing of faces and houses. Strong and widespread orientation effects were found for both faces and houses, from 100-350ms post-stimulus onset, including P1 and N170 components, and later, a finding arguing against a lack of holistic processing for houses. While no clear fixation effect was found for houses, fixation location strongly impacted face processing early, reflecting retinotopic mapping around the C2 and P1 components, and during the N170-P2 interval. Face inversion effects were also largest for nasion fixation around 120ms. The results support the view that facial feature integration (1) depends on which feature is being fixated and where the other features are situated in the visual field, (2) occurs maximally during the P1-N170 interval when fixation is on the nasion and (3) continues past 200ms, suggesting the N170 peak, where weak effects were found, might be an inflexion point between processes rather than the end of a feature integration into a whole process.

A prospective multi-center study quantifying visual inattention in delirium using generative models of the visual processing stream

The visual attentional deficits in delirium are poorly characterized. Studies have highlighted neuro-anatomical abnormalities in the visual processing stream but fail at quantifying these abnormalities at a functional level. To identify these deficits, we undertook a multi-center eye-tracking study where we recorded 210 sessions from 42 patients using a novel eye-tracking system that was made specifically for free-viewing in the (ICU); each session lasted 10 min and was labeled with the delirium status of the patient using the Confusion Assessment Method in ICU (CAM-ICU). To analyze this data, we formulate the task of visual attention as a hierarchical generative process that yields a probabilistic distribution of the location of the next fixation. This distribution can then be compared to the measured patient fixation producing a correctness score which is tallied compared across delirium status. This analysis demonstrated that the visual processing system of patients suffering from delirium is functionally restricted to a statistically significant degree. This is the first study to explore the potential mechanisms underpinning visual inattention in delirium and suggests a new target of future research into a disease process that affects one in four hospitalized patients with severe short and long-term consequences.

Understanding the visual search strategies of expert and novice coaches in futsal set pieces.

This study aimed to describe the fixation location and the time of the longer fixation of expert and novice futsal coaches before the ball was in play in futsal set pieces. A total of 10 experts (ages 48 ± 5) and 10 novice coaches (ages 40 ± 7) participated in the study. They observed that 38 video clips were created to mimic the attack and defensive set-piece moments of the game. Data were collected in a standardized video analysis task using the pupil invisible eye tracker and processed through the pupil cloud platform. The Mann-Whitney test was conducted to evaluate differences in gaze duration between game moments (attack and defense set pieces) and groups (expert vs. novice). Gaze duration was also compared for gaze location between groups. For further comparisons, the game moments (attack and defense set pieces) and the gaze location were summarized in two-dimensional graphics using correspondence analysis. The results revealed higher values of gaze duration for attack and defense set pieces for the group of experts than for novices. When considering gaze duration, expert coaches had higher values than novices for the attacker 3, defender 3, barrier 1st, and barrier 2nd gaze locations. The correspondence analysis showed different strategies of visual search and, consequently, gaze locations for attack and defense set pieces. In particular, there was different correspondence for free kicks between the level of expertise and gaze location, while corner and sideline kicks revealed some correspondence between the groups and the gaze location. In free kicks, coaches should be particularly concerned about the relationship between attacker and defender three and the barrier 1st and 2nd line positions. In corner and sideline kicks, coaches should be particularly aware of the relationship between attackers' and defenders' positions.

Sensorimotor prediction is used to direct gaze toward task-relevant locations in a goal-directed throwing task.

Previous research has shown that action effects of self-generated movements are internally predicted before outcome feedback becomes available. To test whether these sensorimotor predictions are used to facilitate visual information uptake for feedback processing, we measured eye movements during the execution of a goal-directed throwing task. Participants could fully observe the effects of their throwing actions (ball trajectory and either hitting or missing a target) in most of the trials. In a portion of the trials, the ball trajectory was not visible, and participants only received static information about the outcome. We observed a large proportion of predictive saccades, shifting gaze toward the goal region before the ball arrived and outcome feedback became available. Fixation locations after predictive saccades systematically covaried with future ball positions in trials with continuous ball flight information, but notably also in trials with static outcome feedback and only efferent and proprioceptive information about the movement that could be used for predictions. Fixation durations at the chosen positions after feedback onset were modulated by action outcome (longer durations for misses than for hits) and outcome uncertainty (longer durations for narrow vs. clear outcomes). Combining both effects, durations were longest for narrow errors and shortest for clear hits, indicating that the chosen locations offer informational value for feedback processing. Thus, humans are able to use sensorimotor predictions to direct their gaze toward task-relevant feedback locations. Outcome-dependent saccade latency differences (miss vs. hit) indicate that also predictive valuation processes are involved in planning predictive saccades.NEW & NOTEWORTHY We elucidate the potential benefits of sensorimotor predictions, focusing on how the system actually uses this information to optimize feedback processing in goal-directed actions. Sensorimotor information is used to predict spatial parameters of movement outcomes, guiding predictive saccades toward future action effects. Saccade latencies and fixation durations are modulated by outcome quality, indicating that predictive valuation processes are considered and that the locations chosen are of high informational value for feedback processing.

Biomechanics as support for forensic expert reports in after pedestrian-car collisions

This paper systematically explores the mechanical properties of facial and cranial bones, aiming to contribute to the understanding of brain and cervical spine injuries from a mechanical/biomechanical perspective. The research also seeks to provide insights applicable in forensic practice, bridging the gap for engineering professionals not typi-cally involved in forensic medicine. Strength and stiffness parameters of facial and cra-nial bones were utilized to analyze forces leading to fractures, proposing a simple analyt-ical approach for determining head velocity upon striking a car windshield. Experimental testing was conducted to examine defects on the windshield resulting from an impactor's crash, simulating head impacts at varying velocities. Two approaches for determining head impact velocity during pedestrian-car collisions were explored. The first, neglect-ing body deformation effects, assumes that the manikin's center of gravity moves at the same speed as the impacting vehicle, resulting in an impact velocity that is approximate-ly twice the car's speed. The second, a more realistic scenario, considers slower move-ment of the body's center of gravity, yielding an impact velocity that is about one and a half times the car's speed, with a specific angle relative to the X-axis. Calculation reveals that head impact velocity decreases with reduced windshield inclination at constant ve-hicle speed. Experimental testing with an adult head impactor monitored impact velocity, acceleration, contact time, and puncture diameter and depth on the vehicle glass. Results align closely with published data, emphasizing higher injury risk near the location of fixation of the windshield to the frame of the vehicle. In forensic investigations, the re-search findings, including newly measured or calculated parameters, offer practical ap-plications. Acknowledging simulation limitations, the study emphasizes the reliance on experimental data for a more realistic understanding. Application of knowledge in expert opinions for car crashes with injuries involves considering windshield defect dimen-sions in relation to speed, minimizing the need for revision by expert opinions. This comprehensive exploration contributes to understanding biomechanical factors influenc-ing injuries, particularly in vehicular accidents, and underscores the importance of em-pirical data in forensic practice. The proposed analytical approach and experimental insights provide valuable tools for forensic professionals and contribute to the broader understanding of injury mechanisms.

SeqRank: Sequential Ranking of Salient Objects

Salient Object Ranking (SOR) is the process of predicting the order of an observer's attention to objects when viewing a complex scene. Existing SOR methods primarily focus on ranking various scene objects simultaneously by exploring their spatial and semantic properties. However, their solutions of simultaneously ranking all salient objects do not align with human viewing behavior, and may result in incorrect attention shift predictions. We observe that humans view a scene through a sequential and continuous process involving a cycle of foveating to objects of interest with our foveal vision while using peripheral vision to prepare for the next fixation location. For instance, when we see a flying kite, our foveal vision captures the kite itself, while our peripheral vision can help us locate the person controlling it such that we can smoothly divert our attention to it next. By repeatedly carrying out this cycle, we can gain a thorough understanding of the entire scene. Based on this observation, we propose to model the dynamic interplay between foveal and peripheral vision to predict human attention shifts sequentially. To this end, we propose a novel SOR model, SeqRank, which reproduces foveal vision to extract high-acuity visual features for accurate salient instance segmentation while also modeling peripheral vision to select the object that is likely to grab the viewer’s attention next. By incorporating both types of vision, our model can mimic human viewing behavior better and provide a more faithful ranking among various scene objects. Most notably, our model improves the SA-SOR/MAE scores by +6.1%/-13.0% on IRSR, compared with the state-of-the-art. Extensive experiments show the superior performance of our model on the SOR benchmarks. Code is available at https://github.com/guanhuankang/SeqRank.

Arthroscopic suprapectoral biceps tenodesis utilizing the subacromial locking stitch anchor (SALSA) technique

Biceps tenodesis is an accepted treatment option for various pathologies of the long head of the biceps tendon (LHBT) and labrum. Many techniques have been published, both arthroscopic and open, that utilize various fixation techniques and locations of the tenodesis, yet none has been proven to be superior. We introduce a novel method, the S.A.L.S.A (subacromial locking stitch anchor), of all-arthroscopic suprapectoral biceps tenodesis utilizing a running locking stitch from a double loaded biocomposite anchor. This technique provides a reliable method of multi-point fixation including the transverse humeral ligament that avoids many of the potential complications encountered with other techniques.

Cartilage tympanoplasty for retraction pocket of the tympanic membrane in children.

Retraction pocket (RP) of the tympanic membrane (TM) is a common pathology in children that can cause ossicular chain erosion, cholesteatoma formation, and potentially life-threatening complications of cholesteatoma. This study assessed the functional and anatomical results of cartilage grafting in children with severe RP of the TM. This was a retrospective review of 212 children from a tertiary referral center. We identified significant differences in hearing results, indication criteria, and location of TM fixation between stages II and III of RP (according to Charachon). We observed a significantly higher incidence of RP in boys than in girls. Cartilage tympanoplasty for retraction pocket of the tympanic membrane in children is a safe procedure with good anatomical and hearing results.

Presaccadic Attention Depends on Eye Movement Direction and Is Related to V1 Cortical Magnification.

With every saccadic eye movement, humans bring new information into their fovea to be processed with high visual acuity. Notably, perception is enhanced already before a relevant item is foveated: During saccade preparation, presaccadic attention shifts to the upcoming fixation location, which can be measured via behavioral correlates such as enhanced visual performance or modulations of sensory feature tuning. The coupling between saccadic eye movements and attention is assumed to be robust and mandatory and considered a mechanism facilitating the integration of pre- and postsaccadic information. However, until recently it had not been investigated as a function of saccade direction. Here, we measured contrast response functions during fixation and saccade preparation in male and female observers and found that the pronounced response gain benefit typically elicited by presaccadic attention is selectively lacking before upward saccades at the group level-some observers even showed a cost. Individual observer's sensitivity before upward saccades was negatively related to their amount of surface area in primary visual cortex representing the saccade target, suggesting a potential compensatory mechanism that optimizes the use of the limited neural resources processing the upper vertical meridian. Our results raise the question of how perceptual continuity is achieved and how upward saccades can be accurately targeted despite the lack of-theoretically required-presaccadic attention.

Efficacy of all-inside devices in reducing gap and step-off in knee extension for ramp lesion repair: A cadaveric study.

The aim of this study is to assess the dynamics of the tear site of meniscal ramp lesions, particularly considering knee flexion angles, and validate anchor fixation using an all-inside device. Eight Thiel-embalmed paired cadaveric knees with their whole bodies were used in this study. The ramp lesions were created arthroscopically, and ramp lesion dynamics were evaluated by gradually extending the knee from 90° of knee flexion. Changes in the gap and step-off (0: no step-off; 1: cross-sectional overlap exists; and 2: tibial articular surface exposed) were evaluated at 90°, 60°, 30°, and 10° of knee flexion. After dynamic evaluation, all-inside repairs of the ramp lesions using all-inside devices were conducted. Dissection was performed to confirm the position of anchor fixation. As the knee was extended, the gap significantly decreased at all knee flexion angles. Similarly, the step-off grade decreased as the knee was extended, and the step-off completely disappeared in all cases when the knee was extended from 30° to 10°. The average knee flexion angle at which the gap and step-off completely disappeared was 22.5°. After suturing the ramp lesion, arthroscopic evaluation showed that the gap had disappeared and the step-off had been repaired in all cases. Anchor fixation locations were not found within the joint but were fixed to the semimembranosus tendon or its surrounding articular capsule. Overall, 31% (5/16) anchors were fixed to the attachment site of the semimembranosus tendon, whereas the remaining were fixed to the articular capsule, located peripherally to the semimembranosus tendon. Suturing with an all-inside device for ramp lesions is a good option, and the repair in knee extension was found to be reasonable, considering the dynamics of ramp lesions in this study. Level IV.

Altered attentional processing of facial expression features in severe alcohol use disorder: An eye-tracking study.

Social cognition impairments, and notably emotional facial expression (EFE) recognition difficulties, as well as their functional and clinical correlates, are increasingly documented in severe alcohol use disorder (SAUD). However, insights into their underlying mechanisms are lacking. Here, we tested if SAUD was associated with alterations in the attentional processing of EFEs. In a preregistered study, 40 patients with SAUD and 40 healthy controls (HCs) had to identify the emotional expression conveyed by faces while having their gaze recorded by an eye-tracker. We assessed indices of initial (first fixation locations) and later (number of fixations and dwell-time) attention with reference to regions of interest corresponding to the eyes, mouth, and nose, which carry key information for EFE recognition. We centrally found that patients had less first fixations to key facial features in general, as well as less fixations and dwell time to the eyes specifically, relative to the rest of the face, compared to controls. These effects were invariant across emotional expressions. Additional exploratory analyses revealed that patients with SAUD had a less structured viewing pattern than controls. These results offer novel, direct, evidence that patients with SAUD's socioaffective difficulties already emerge at the facial attentional processing stage, along with precisions regarding the nature and generalizability of the effects. Potential implications for the mechanistic conceptualization and treatment of social cognition difficulties in SAUD are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Diagnosing Middle Ear Malformation by Pure-Tone Audiometry Using a Three-Dimensional Finite Element Model: A Case-Control Study

Background: Hearing loss caused by middle ear malformations is treated by tympanoplasty to reconstruct the acoustic conduction system. The mobility of the ossicles plays a crucial role in postoperative success. However, identifying the location of ossicular malformation based solely on preoperative audiograms is challenging due to the complex relationship between fixation location, deformity levels, and ossicular mobility. Methods: Middle ear finite element models for simulating ossicular malformations were created, and the results were compared with the actual preoperative audiograms. Results: This approach objectively diagnosed ossicular fixation and disarticulation, bypassing traditional criteria reliant on physician examination or imaging. Conclusion: This study suggests that future research should focus on developing a diagnostic framework utilizing large-scale data.