Target Alignment Research Articles

Prevalence of proximal tibia vara in Indonesian population with knee osteoarthritis

BackgroundProximal tibia vara has drawn interest since the concept of constitutional varus was introduced. Proximal tibia vara is a condition where the knee varus tilt the tibia condyle medially and shift the tibial articular surface medially. This condition affects medial proximal tibial angle measurements and the placement of the tibial implant in knee replacement surgery. Thus, it challenged the neutral knee arthroplasty alignment target because some people may present a proximal tibia vara. This study assesses the prevalence of the proximal tibia vara and the correlation to knee osteoarthritis grade. MethodsThis retrospective study was carried out from January 2021 to June 2021. Eighty-five limbs were included with the following inclusion criteria: knee osteoarthritis patients who received a long view lower extremity radiograph. The exclusions criteria were (1) patients who had undergone arthroplasty and lower extremity surgery before and (2) valgus knee deformity. The outcomes in this study were HKAA, MAD, TAD, MPTA, PTRP, LDFA, and PTS. Intraclass correlation (ICC) using two-way mixed was used to assess the reproducibility of the radiographic parameters. Multiple logistic regression was used to evaluate the correlation between knee osteoarthritis grade and radiographs parameters (MAD and TAD). ResultA total 85 limbs from 52 patients were assessed in this study. Proximal tibia vara was found in 18 knees (21%.). The logistic regression was performed to assess the correlation between the severity of the knee osteoarthritis and radiographic parameters (MAD, TAD, LDFA, and PTS) with an overall p-value < 0.001 and pseudo-R2 = 0.29. ConclusionA significant portion of patients with knee osteoarthritis have proximal tibia vara, and it is a pre-existing condition. Since the pre-existing proximal tibia vara affects preoperative measurements, a long-standing lower extremity x-ray is recommended to be obtained as part of knee replacement preparation.

Image-Free Robotic-Assisted Total Knee Arthroplasty Improves Implant Alignment Accuracy: A Cadaveric Study.

Improving resection accuracy and eliminating outliers in total knee arthroplasty (TKA) is important to improving patient outcomes regardless of alignment philosophy. Robotic-assisted surgical systems improve resection accuracy and reproducibility compared to conventional instrumentation. Some systems require preoperative imaging while others rely on intraoperative anatomic landmarks. We hypothesized that the alignment accuracy of a novel image-free robotic-assisted surgical system would be equivalent or better than conventional instrumentation with fewer outliers. Forty cadaveric specimens were used in this study. Five orthopedic surgeons performed 8 bilateral TKAs each, using the VELYS Robotic-Assisted System (DePuy Synthes) and conventional instrumentation on contralateral knees. Pre-resection and postresection computed tomography scans, along with optical scans of the implant positions were performed to quantify resection accuracies relative to the alignment targets recorded intraoperatively. The robotic-assisted cohort demonstrated smaller resection errors compared to conventional instrumentation in femoral coronal alignment (0.63° ± 0.50° vs 1.39° ± 0.95°, P < .001), femoral sagittal alignment (1.21° ± 0.90° vs 3.27° ± 2.51°, P < .001), and tibial coronal alignment (0.93° ± 0.72° vs 1.65° ± 1.29°, P= .001). All other resection angle accuracies were equivalent. Similar improvements were found in the femoral implant coronal alignment (0.89° ± 0.82° vs 1.42° ± 1.15°, P= .011), femoral implant sagittal alignment (1.51° ± 1.08° vs 2.49° ± 2.10°, P= .006), and tibial implant coronal alignment (1.31° ± 0.84° vs 2.03° ± 1.44°, P= .004). The robotic-assisted cohort had fewer outliers (errors >3°) for all angular resection alignments. This invitro study demonstrated that image-free robotic-assisted TKA can improve alignment accuracy compared to conventional instrumentation and reduce the incidence of outliers.

Predicting Mechanical Failure Following Cervical Deformity Surgery: A Composite Score Integrating Age-Adjusted Cervical Alignment Targets.

Retrospective cohort study. Investigate a composite score to evaluate the relationship between alignment proportionality and risk of distal junctional kyphosis (DJK). 84 patients with minimum 1year follow-up were included (age = 61.1 ± 10.3years, 64.3% women). The Cervical Score was constructed using offsets from age-adjusted normative values for sagittal vertical axis (SVA), T1 Slope (TS), and TS minus cervical lordosis (CL). Individual points were assigned based on offset with age-adjusted alignment targets and summed to generate the Cervical Score. Rates of mechanical failure (DJK revision or severe DJK [DJK> 20° and ΔDJK> 10°]) were assessed overall and based on Cervical Score. Logistical regressions assessed associations between early radiographic alignment and 1-year failure rate. Mechanical failure rate was 21.4% (N = 18), 10.7% requiring revision. By multivariate logistical regression: 3-month T1S (OR: .935), TS-CL (OR:0.882), and SVA (OR:1.015) were independent predictors of 1-year failure (all P < .05). Cervical Score ranged (-6 to 6), 37.8% of patients between -1 and 1, and 50.0% with 2 or higher. DJK patients had significantly higher Cervical Score (4.1 ± 1.3 vs .6 ± 2.2, P < .001). Patients with a score ≥3 were significantly more likely to develop a failure (71.4%) with OR of 38.55 (95%CI [7.73; 192.26]) and Nagelkerke r2 .524 (P < .001). This study developed a composite alignment score predictive of mechanical failures in CD surgery. A score ≥3 at 3months following surgery was associated with a marked increase in failure rate. The Cervical Score can be used to analyze sagittal alignment and help define realignment objectives to reduce mechanical failure.

Validation and modification of the Coronal Plane Alignment of the Knee classification in the Asian population.

AimsThe Coronal Plane Alignment of the Knee (CPAK) classification is a simple and comprehensive system for predicting pre-arthritic knee alignment. However, when the CPAK classification is applied in the Asian population, which is characterized by more varus and wider distribution in lower limb alignment, modifications in the boundaries of arithmetic hip-knee-ankle angle (aHKA) and joint line obliquity (JLO) should be considered. The purposes of this study were as follows: first, to propose a modified CPAK classification based on the actual joint line obliquity (aJLO) and wider range of aHKA in the Asian population; second, to test this classification in a cohort of Asians with healthy knees; third, to propose individualized alignment targets for different CPAK types in kinematically aligned (KA) total knee arthroplasty (TKA).MethodsThe CPAK classification was modified by changing the neutral boundaries of aHKA to 0° ± 3° and using aJLO as a new variable. Radiological analysis of 214 healthy knees in 214 Asian individuals was used to assess the distribution and mean value of alignment angles of each phenotype among different classifications based on the coronal plane. Individualized alignment targets were set according to the mean lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) of different knee types.ResultsA very high concentration, 191 from 214 individuals (89.3%), were found in knee types with apex distal JLO when the CPAK classification was applied in the Asian population. By using aJLO as a new variable, the high distribution percentage in knee types with apex distal JLO decreased to 125 from 214 individuals (58.4%). The most common types in order were Type II (n = 70; 32.7%), Type V (n = 55; 25.7%), and Type I (n = 46; 21.5%) in the modified CPAK classification.ConclusionThe modified CPAK classification corrected the uneven distribution when applying the CPAK classification in the Asian population. Setting individualized TKA alignment targets according to CPAK type may be a practical method to recreate optimal LDFA and MPTA in KA-TKA.Cite this article: Bone Jt Open 2022;3(3):211–217.

440 Have We Made Temporal Advancements in Optimizing Surgical Outcomes and Recovery for High Risk Spinal Deformity Patients?

INTRODUCTION: Surgical correction of adult spinal deformity (ASD) has high rates of complication. However, patients often derive significant benefits in functional status and quality of life from surgery despite high-risk status. It has yet to be investigated whether spine surgeons are improving surgery for high risk patients and minimizing poor outcomes. METHODS: Included: operative ASD pts =18 yrs with pre-(BL) and 2-year (2Y) postop radiographic/HRQL data. Pts were categorized as having undergone surgery from 2009 to 2013[Early] or 2014 to 2018[Late]. High risk [HR] pts were defined as meeting =2 of the following BL criteria: 1) ++PILL or SVA by SRS-Schwab, 2) elderly [=70yrs], 3) severe frailty[Miller index], 4) high CCI [=1 SD above cohort mean], 5) three column osteotomy, and 6) fusion of &gt;12 levels, or &gt;7 levels for elderly pts. Differences in Smith et al. best/worst clinical outcomes, radiographic alignment targets(SRS-Schwab, age-adjusted, GAP score), and complication rates were assessed by time of surgery(Early/Late) for HR pts. RESULTS: 725 ASD pts included (61yrs, 77%F, CCI: 1.82±1.74, levels fused 11.0±4.4). 18.5% underwent 3CO. SRS-Schwab modifiers at BL: 41.4% ++PI-LL, 30.3% ++SVA, 28.8% ++PT. 47% of pts (n=338) had surgery prior to 2014[Early], and 53% (n=387) underwent surgery in 2014 or later[Late]. Overall, 52% of pts (n=377) were deemed high risk[HR]. There was a higher proportion of HR pts in the Late group (p=0.028). In terms of individual HR criteria: Late pts were older, more likely to be ++PI-LL at BL, had higher CCI, and were less likely to undergo 3CO (all p&lt;0.05). Analysis of HR pts by Early/Late status showed no significant differences in radiographic alignment by SRS-Schwab, age-adjusted target, or GAP score by 2Y (all p&gt;0.05). Late/HR pts were less likely to have a poor outcome by Smith et al. definition for SRS and ODI (both p&lt;0.01). Late/HR pts had lower rates of complication, reoperation, deep surgical infection, early PJK (before 6 months), and PJF by 2Y (p&lt;0.05). CONCLUSION: Over time in our data set, spine surgeons have both increased and optimized operating on high risk patients, while minimizing the occurrence of poor clinical outcomes and reducing complication rates.

Poor Accuracy of Intraoperation Medial Proximal Tibial Angle Measurement Compared to Alignment Rod Methods in Open-Wedge High Tibial Osteotomy for Medial Knee Osteoarthritis.

The alignment rod is widely used as an index for intraoperative alignment but alignment error is inevitable. The purpose of this study was to verify the accuracy of lower limb alignment correction by measurement of mechanical medial proximal tibial angle (MPTA) as an index in open-wedge high tibial osteotomy (OWHTO). This study was retrospective case series. This study involved 152 patients undergoing OWHTO for primary medial osteoarthritis. Alignment rod or MPTA measurement board was used as an index of optimal correction in OWHTO. Alignment rod was used from October 2013 to May 2017, and MPTA measurement board was used from June 2017 to April 2020. The correction using an alignment rod was that the weight-bearing line ratio (WBLR) passed through 62.5% of the tibial plateau which was defined as Fujisawa's point under intraoperative fluoroscopy (A rod group). The correction using MPTA measurement board was aligning the intraoperative MPTA to the preplanned angle (MPTA group). Preplanned optimal alignment was defined as Fujisawa's point in all patients. Knee injury and osteoarthritis outcome measure (KOOS), Knee Society scoring system objective knee score (KSS), 3-m timed up-and-go test (TUG), single-limb standing test (SLS), and isometric muscle strength of quadriceps and hamstrings were assessed as clinical results. WBLR, MPTA, joint-line convergence angle (JLCA), and joint-line obliquity (JLO) were assessed as radiological results preoperatively and at 1 year after surgery. The clinical and radiological results after OWHTO were compared with both groups. Postoperative WBLR in A rod group was closer to the target alignment (Fujisawa's point: 62.5) than in the MPTA group at all stage (A rod group vs. MPTA group: 63.1 vs. 54.6 at 6 months; 62.0 vs. 53.4 at 1 year; p < 0.001). There were no significant differences in the clinical results between both groups. The intraoperative measurement of medial proximal tibial angle has a risk of undercorrection after OWHTO. His study is a retrospective case series and reflects level of evidence IV.

Proceedings to the 7th Annual Conference of the Particle Therapy Cooperative Group North America (PTCOG-NA)

Proceedings to the 7th Annual Conference of the Particle Therapy Cooperative Group North America (PTCOG-NA)

Is the lateral tibial spine a reliable landmark for planning tibial or femoral valgus osteotomies?

IntroductionA valgus osteotomy around the knee is a conservative procedure performed to unload the medial tibiofemoral compartment. However, the optimal postoperative alignment target remains controversial. Many studies have applied a “Fujisawa point” at 62.5%. The results of recent studies suggest decreasing the range of the mechanical axis target correction to 50–55%. The primary purpose of this study was to define the mean position of the lateral tibial spine in healthy patients from a reproducible 3-dimensional (3D) analysis. The study hypothesis was that the apex of the lateral tibial spine was a reliable and reproducible landmark for planning valgus osteotomies and preventing overcorrections. Materials and methodsThe study included 1140 patients: 560 women and 580 men, with a mean age of 61.7±16.5 years (18–98) and a mean body mass index (BMI) of 24.9±4.9kg/m2 (13.3–54.6). This analysis was done with the Stryker Orthopaedics Modeling and Analytics (SOMA) system which uses a database of computed tomography (CT) scans and 3D bone models. A statistical assessment was performed to determine the mean position of the lateral tibial spine. These measurements were then compared according to ethnicity, sex, age, BMI, knee side (right and left) and the overall mechanical axis of the leg. ResultsThe mean tibial plateau width was 72.9±5.7mm (59.1–91.1). The mean position of the lateral tibial spine was 53.6±1.1% (48.9–57.2). The mean position of the medial tibial spine was 48.4±2.5% (43.6–56.1) while the center of the tibial spines was 51.0±1.5% (46.4–56.1). Africans had a significantly more lateral mean tibial spine position than Asians (54.7% vs. 53.3%, p=0.001), Caucasians (54.7% vs. 53.7%, p=0.002) and Middle Easterners (54.7% vs. 53.6%, p=0.034). ConclusionThe lateral tibial spine is a simple and reproducible bony landmark. This landmark can be used when planning valgus osteotomies aiming for a “Fujisawa point” at 54%. Level of evidenceIV.

Head-to-Head Comparison of Kinematic Alignment Versus Mechanical Alignment for Total Knee Arthroplasty

BackgroundSeeing as there are many alignment strategies for total knee arthroplasty (TKA), we need to determine differences between them in a rigorous scientific way. Therefore, we sought to compare perioperative and postoperative functional outcomes in patients undergoing TKA for varus osteoarthritis with a mechanical alignment target vs a kinematic alignment target, both executed with the same implant and same technological guidance. MethodsOne hundred consecutive patients who underwent TKA using a mechanical alignment technique were 1:1 matched to 100 patients who underwent TKA using a kinematic alignment (KA) technique, using the same implant and robotic technology. Patient-reported outcomes were measured postoperatively at 1 and 2 years. Power analysis revealed 94 patients to detect a significant difference. ResultsMean Visual Analog Scale scores were higher in the mechanical alignment group during the first 6 weeks (P = .04), but statistically similar at 1 year. Six-week Veterans RAND 12 Item Health Survey mental and physical components were statistically similar (P = .1). Patients did not differ in 6-week or 1-year knee range of motion (P > .43). Knee Injury and Osteoarthritis Outcome Score Joint Replacement was significantly better in the KA group at 6 weeks, 1 year, and 2 years (P = .09). Forgotten Joint Score at 1 and 2 years postoperatively were significantly higher in the KA group (P < .001). ConclusionPatients undergoing TKA with KA experienced less pain in 6 weeks after surgery, and higher Forgotten Joint Scores at 1 and 2 years postoperatively. Alternative TKA alignment and balancing strategies should be considered to increase patient satisfaction.

ProALIGN: Directly Learning Alignments for Protein Structure Prediction via Exploiting Context-Specific Alignment Motifs.

Template-based modeling (TBM), including homology modeling and protein threading, is one of the most reliable techniques for protein structure prediction. It predicts protein structure by building an alignment between the query sequence under prediction and the templates with solved structures. However, it is still very challenging to build the optimal sequence-template alignment, especially when only distantly related templates are available. Here we report a novel deep learning approach ProALIGN that can predict much more accurate sequence-template alignment. Like protein sequences consisting of sequence motifs, protein alignments are also composed of frequently occurring alignment motifs with characteristic patterns. Alignment motifs are context-specific as their characteristic patterns are tightly related to sequence contexts of the aligned regions. Inspired by this observation, we represent a protein alignment as a binary matrix (in which 1 denotes an aligned residue pair) and then use a deep convolutional neural network to predict the optimal alignment from the query protein and its template. The trained neural network implicitly but effectively encodes an alignment scoring function, which reduces inaccuracies in the handcrafted scoring functions widely used by the current threading approaches. For a query protein and a template, we apply the neural network to directly infer likelihoods of all possible residue pairs in their entirety, which could effectively consider the correlations among multiple residues. We further construct the alignment with maximum likelihood, and finally build a structure model according to the alignment. Tested on three independent data sets with a total of 6688 protein alignment targets and 80 CASP13 TBM targets, our method achieved much better alignments and 3D structure models than the existing methods, including HHpred, CNFpred, CEthreader, and DeepThreader. These results clearly demonstrate the effectiveness of exploiting the context-specific alignment motifs by deep learning for protein threading.

A Patient-specific Approach to Alignment and Proximal Junctional Kyphosis Risk Assessment in Adult Spinal Deformity Surgery: Development and Validation of a Predictive Tool.

This was a single-institution, retrospective cohort study. We aimed to develop a predictive model for proximal junctional kyphosis (PJK) severity that considers multiple preoperative variables and modifiable surgical alignment. PJK is a common complication following adult deformity surgery. Current alignment targets account for age and pelvic incidence but not other risk factors. This is a single-institution, retrospective cohort study of adult deformity patients with a minimum 2-year follow-up undergoing instrumented fusion between 2009 and 2018. A proportional odds regression model was fit to estimate PJK probability and Hart-International Spine Study Group (ISSG) PJK severity score. Predictors included preoperative Charlson Comorbidity Index, vertebral Hounsfield Units near the upper instrumented vertebrae, pelvic incidence, T1-pelvic angle, and postoperative L1-L4 and L4-S1 lordosis. Predictor effects were assessed using adjusted odds ratios and a nomogram constructed for estimating PJK probability. Bootstrap resampling was used for internal validation. Of 145 patients, 47 (32%) developed PJK. The median PJK severity score was 6 (interquartile range, 4-7.5). After adjusting for predictors, Charlson Comorbidity Index, Hounsfield Units, preoperative T1-pelvic angle, and postoperative L1-L4 and L4-S1 lordosis were significantly associated with PJK severity ( P <0.05). After adjusting for potential overfitting, the model showed acceptable discrimination [ C -statistic (area under the curve)=0.75] and accuracy (Brier score=0.10). We developed a model to predict PJK probability, adjusted for preoperative alignment, comorbidity burden, vertebral bone density, and modifiable postoperative L1-L4 and L4-S1 lordosis. This approach may help surgeons assess the patient-specific risk of developing PJK and provide a framework for future predictive models assessing PJK risk after adult deformity surgery. Level III.

Effectiveness of intraoperative tibia fibular angle and femoral fibular angle in predicting coronal lower limb alignment after medial open-wedge high tibial osteotomy

To explore the prediction of postoperative coronal lower limb alignment by the tibia fibular angle (TFA) and femoral fibular angle (FFA) after osteotomy in medial open-wedge high tibial osteotomy (MOWHTO). A clinical data of 20 patients with medial compartment osteoarthritis, who were treated with MOWHTO between September 2019 and September 2020, was retrospectively analyzed. Among them, there were 9 males and 11 females; the age ranged from 46 to 69 years, with an average of 56.0 years. The body mass index (BMI) was 21.3- 35.7 kg/m 2, with an average of 26.7 kg/m 2. Osteoarthritis involved 11 cases of left knee and 9 cases of right knee; the disease duration was 2-6 years, with an average of 3.8 years. According to the Kellgren-Lawrence classification, there were 7 cases of grade Ⅰ, 9 cases of grade Ⅱ, and 4 cases of grade Ⅲ. The angle and height for open-wedge was planned preoperatively by osteotomy master software, and the TFA and FFA were measured by software after simulated osteotomy. The intraoperative angle for open-wedge was adjusted according to TFA and FFA after simulated osteotomy.The lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), mechanical femorotibial angle (mFTA), weight-bearing line (WBL) ratio, TFA, and FFA were measured before operation and at 2 days after operation. The difference (X) between the intraoperative measurement value and the preoperative plan value of TFA/FFA, and the difference (Y) between the postoperative WBL ratio and the target alignment (62.5%) were calculated, and the correlation between the two indicators was analyzed by Pearson's test. According to the median BMI of patients (25.81 kg/m 2), the patients were allocated into high BMI group (>25.81 kg/m 2, n=10) and low BMI group (≤25.81 kg/m 2, n=10), and the influencing factors of WBL ratio was analyzed by linear regression. There was no significant difference between pre- and post-operation in LDFA and JLCA ( P>0.05); while there were significant differences between pre- and post-operation in MPTA, mFTA, and WBL ratio ( P<0.05). The TFA was (89.5±4.0)° during operation and (87.7±4.7)° after operation, showing significant difference ( t=2.991, P=0.008). There was a positive correlation between the difference (X) between the intraoperative measurement value and the preoperative plan value of TFA and the difference (Y) between the postoperative WBL ratio and the target alignment ( r=0.595, P=0.006). The FFA was (86.9±4.3)° during operation and (85.7±4.4)° after operation, showing significant difference ( t=1.760， P=0.094). There was a positive correlation between the difference (X) between the intraoperative measurement value and the preoperative plan value of FFA and the difference (Y) between the postoperative WBL ratio and the target alignment ( r=0.536, P=0.015). After BMI stratification, X was an influential factor of Y in the low BMI group ( P<0.05), but X was not an influential factor of Y in the high BMI group ( P>0.05). Intraoperative FFA and TFA can predict coronal limb alignment after MOWHTO. FFA and TFA can predict more preciselyfor patients with BMI≤25.81 kg/m 2.

Under-correction of preoperative varus alignment does not lead to a difference in in-vivo bone loading in 3D-SPECT/CT compared to neutral alignment

BackgroundThe aim was to investigate the correlation of bone tracer uptake (BTU) in SPECT/CT and changes in coronal knee alignment after total knee arthroplasty (TKA). We questioned if undercorrection of preoperative varus alignment leads to a difference in BTU compared to neutral alignment. MethodsConsecutive 66 patients who received SPECT/CT before and after TKA were retrospectively included. Adjusted mechanical alignment was the alignment target. The alignment of the knee was measured on 3D-CT by selecting standardized landmarks. Maximum (mean ± SD) and relative BTU (ratio to the reference) were recorded using a previously validated localization scheme (p < 0.05). ResultsIn the native group, 20 knees were aligned (30.3%) in valgus (HKA > 181.5°), 12 (18.2%) in neutral (178.5°-181.5°) and 34 (51.5%) in varus (HKA < 178°). Overall TKA changed the alignment towards neutral. 48.5% remained in the same groups, whereas 50% of native valgus and 33% of varus knees changed to neutral after TKA. In native varus alignment mean BTU was significantly higher in some medial tibial and femoral regions (fem1ia (p = 0.010), fem1ip (p = 0.002), tib1a.mid (p = 0.005), tib1a.tray (p = 0.000), tib1p.tray (p = 0.000)); in native valgus alignment mean BTU was higher in the corresponding lateral tibial and femoral regions (fem2ip (p = 0.001), tib2a.tray (p = 0.011), tib2p.tray (p = 0.002)). After TKA, a significant decrease in femoral and tibial BTU (femoral preoperative BTU 1.64 +/-0.69; femoral postoperative BTU 0.95 +/-0.42; p = 0.000// tibial preoperative BTU 1.65 +/- 0.93; tibial postoperative BTU 1.16 +/- 0.48; p = 0.000) and an increase in patellar BTU was observed (p = 0.025). Native varus alignment correlated with a higher medial BTU decrease medially. Undercorrection of preoperative varus alignment showed no higher BTU after TKA. ConclusionPreoperative varus alignment correlated with a higher decrease in BTU in specific femoral and tibial medial regions. Preoperative valgus alignment correlated with a higher decrease in the corresponding lateral regions. Undercorrection of preoperative varus alignment did not lead to higher bone loading reflected by BTU after TKA.

Molecular Epidemiology of SARS-CoV-2 by Sequencing.

Sequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) contains preliminary information on the phylodynamics and phylogeography of this new virus. A maximum clade credibility tree (MCCT) was constructed using available whole genome sequences of SARS-CoV-2 and highly similar whole genome sequences from bat SARS-like coronavirus, which are available in GenBank. In this chapter, we describe the molecular epidemiology of SARS-CoV-2 by sequencing the viral genomes from confirmed COVID-19 patients, utilizing methods such as target fragment amplification, sequencing, alignment, and maximum similarity mapping.

An E2E-ASR-Based Iteratively-Trained Timestamp Estimator

Text-to-speech alignment, also known as time alignment, is essential for automatic speech recognition (ASR) systems used for speech retrieval tasks, such as keyword search and speech segment extraction. Previous works have used the Gaussian mixture model-hidden Markov model (GMM-HMM) forced alignment to improve the alignment performance. However, when used with end-to-end (E2E) ASR, GMM-HMM forced alignment causes extra reliance on expertise such as pronunciation lexica. It also increases the system complexity because GMM-HMMs are very dissimilar to E2E models. To tackle these two problems, we propose an E2E-ASR-based iteratively-trained timestamp estimator (ITSE), which performs alignment between token-level transcription and speech. We train ITSE first with coarse initial alignment targets generated using connectionist temporal classification (CTC) posteriors. During training, we iteratively perform realignment to update the targets. We attribute the effectiveness of the iterative training to ITSE&#x2019;s two vital features. First, ITSE performs alignment using similarities between token and speech embeddings instead of frame-wise token classification posteriors. Second, ITSE uses speech embeddings that are aware of left context rather than global context. ITSE significantly outperforms CTC-based baselines in word alignment accuracy and is comparable to a GMM-HMM forced aligner. In short, ITSE is an accurate, lightweight text-to-speech alignment module implemented without expertise such as pronunciation lexica.

Optimization of target alignment in inertial confinement fusion facilities based on redundant measurements

Target alignment technology is one of the most essential technologies in inertial confinement fusion facilities, and is directly related to the results of high-energy physics experiments. In this study, we examine the error in the target alignment scheme, classify the error based on the source and performance, minimize the error through redundant measurement methods (target fusion and sensor fusion), and improve the precision of the target alignment scheme. By integrating these methods, the alignment error of the target is considerably improved and the position uncertainty is reduced.

Prosodic realization of tonal target and F0 peak alignment in Mandarin neutral tone

Abstract Neutral tone in Mandarin is generally believed to lack tonal identity and exhibit more variability in its phonetic realization. We examined the tonal target of neutral tone in a prosodic word consisting of a full syllable (S) and one, two, or three neutral-tone syllables. In the experiment, the test words, presented in isolation and embedded in a carrier sentence, were read in two intonation patterns: declarative and interrogative. The results showed: (1) the tonal target of neutral tone is L(ow) at the end of the intonation phrase in declarative intonation and M(id) in question intonation; (2) its phonetic realization is influenced by intonation patterns, the tone of S and the number of neutral-tone syllables in the prosodic word; (3) the influence of the tone of S is more robust in shorter sequences than in longer ones with three neutral-tone syllables; (4) placement of the F0 peak in T2 (LH) and the neutral tone immediately following T3 (L) is susceptible to the number of neutral-tone syllables. It seems clear from our study that while the tonal target of neutral tone is related to prosodic structure, its actual F0 scaling is sensitive to prosodic manipulations such as intonation patterns and prosodic word length. In addition, tonelessness of neutral tone allows for more freedom in the alignment of the F0 peak, whose temporal coordination with its segmental host is, nevertheless, subject to both phonological and phonetic constraints.

Analysis of Balanced Scorecard Implementation as Performance Management System at Deputy for Law Enforcement – Indonesian FDA

Deputy for Law Enforcement (Deputy IV) is a strategy for strengthening the Indonesian FDA (BPOM) in responding to future law enforcement challenges that have functions and duties of the regulation and comprehensively eliminate crime in the Drug and Food sectors. They required a well-planned strategic plan to carry out their tasks and responsibilities, including a performance management system based on the Balanced Scorecard (BSC) approach. This research aims to evaluate the effectiveness of Balanced Scorecard (BSC) implementation at Deputy IV. The qualitative descriptive methodology was used in this research, analyzing primary data sources obtained through interviews with internal stakeholders. The result shows that there are essential factors on each system performance evaluation category such as integrity, commitment, responsibility, strategy map, key performance indicator (KPI), cascading, valid and balanced measurement, realistic target, individual and objective alignment, cascading, human resources, budgeting process, strategic planning process, data collection, and reporting. The recommendation, Deputy IV must be maintained the essential factors of BSC implementation to improve their future performance. This research is intended to assist public officials as policymakers in strategic planning and performance management evaluation.

Deriving global carbon budgets for the Swiss built environment

In order to limit global warming, remaining carbon budgets have been defined by the IPCC in 2018. In this context translating global goals to local realities implicates a set of different challenges. Standardized methodologies of allocation can support a target-cascading process. On the other hand, local strategies and norms are not currently designed to directly respond to limited carbon budgets in a 2050 horizon. The life cycle assessment of buildings implicates an intricate cross-industry and cross-border carbon accounting. For these reasons, effective and aligned carbon targets are needed to support and guide all actors in the construction sector. This research aims at addressing these challenges by developing a new methodology of allocation of a global carbon budget at different scales using the Swiss built environment as a case study. This approach allows the assessment of current best practices in regards to limited carbon budgets. Results show misalignment of global goals with current practices at all levels and present the magnitude of effort that would be required to have a chance to limit global warming to 1.5°C.

Prioritization of Realignment Associated With Superior Clinical Outcomes for Cervical Deformity Patients.

ObjectiveTo prioritize the cervical parameter targets for alignment. MethodsIncluded: cervical deformity (CD) patients (C2–7 Cobb angle > 10°, cervical lordosis > 10°, cervical sagittal vertical axis [cSVA] > 4 cm, or chin-brow vertical angle > 25°) with full baseline (BL) and 1-year (1Y) radiographic parameters and Neck Disability Index (NDI) scores; patients with cervical [C] or cervicothoracic [CT] Primary Driver Ames type. Patients with BL Ames classified as low CD for both parameters of cSVA (< 4 cm) and T1 slope minus cervical lordosis (TS–CL) (< 15°) were excluded. Patients assessed: meeting minimum clinically important differences (MCID) for NDI (< -15 ΔNDI). Ratios of correction were found for regional parameters categorized by primary Ames driver (C or CT). Decision tree analysis assessed cutoffs for differences associated with meeting NDI MCID at 1Y. ResultsSeventy-seven CD patients (mean age, 62.1 years; 64% female; body mass index, 28.8 kg/m2). Forty-one point six percent of patients met MCID for NDI. A backwards linear regression model including radiographic differences as predictors from BL to 1Y for meeting MCID for NDI demonstrated an R2 of 0.820 (p=0.032) included TS–CL, cSVA, McGregor’s slope (MGS), C2 sacral slope, C2–T3 angle, C2–T3 SVA, cervical lordosis. By primary Ames driver, 67.5% of patients were C, and 32.5% CT. Ratios of change in predictors for MCID NDI patients for C and CT were not significant between the 2 groups (p>0.050). Decision tree analysis determined cutoffs for radiographic change, prioritizing in the following order: ≥ 42.5° C2–T3 angle, > 35.4° cervical lordosis, < -31.76° C2 slope, < -11.57-mm cSVA, < -2.16° MGS, > -30.8-mm C2–T3 SVA, and ≤ -33.6° TS–CL. ConclusionCertain ratios of correction of cervical parameters contribute to improving neck disability. Prioritizing these radiographic alignment parameters may help optimize patient-reported outcomes for patients undergoing CD surgery.