Threshold Criteria Research Articles

Ruxolitinib Cream in Adolescents/Adults with Atopic Dermatitis Meeting Severity Thresholds for Systemic Therapy: Exploratory Analysis of Pooled Results from Two Phase3 Studies.

Standard therapy for patients with mild to moderate atopic dermatitis (AD) typically includes topical therapies; however, patients with more extensive AD and/or AD refractory to topical therapy may benefit from systemic treatment. Ruxolitinib cream monotherapy has demonstrated superior antipruritic and anti-inflammatory effects versus vehicle in patients with mild to moderate AD, and long-term disease control with as-needed use. Here, efficacy/safety of 1.5% ruxolitinib cream through 52weeks was assessed in a subset of patients with moderate and/or more extensive disease. This post hoc analysis of TRuE-AD1/TRuE-AD2 included patients who, at baseline, had Investigator's Global Assessment (IGA) score of 3, Eczema Area and Severity Index (EASI) ≥ 16, and affected body surface area (BSA) ≥ 10% (higher severity of disease threshold subgroup). Disease control and safety were assessed. Of 1249 patients in the overall population, 78 (6.2%) met all higher severity of disease threshold criteria (continuous-use vehicle-controlled period: 1.5% ruxolitinib cream, n = 32; vehicle, n = 13); 28 and 4 of these patients, respectively, continued as-needed 1.5% ruxolitinib cream during the long-term safety (LTS) period. At week8 (continuous-use), IGA-treatment success (IGA0/1, with ≥ 2-grade improvement from baseline) was achieved by 19/32 (59.4%) patients applying 1.5% ruxolitinib cream versus no patients applying vehicle. In the LTS period, those achieving clear/almost clear skin increased from 19/28 patients (67.9%; continuous-use: week8) to 18/23 patients (78.3%; as-needed use: week52) in patients applying ruxolitinib cream from day1. Ruxolitinib cream was well tolerated, with few application site reactions, regardless of disease severity threshold. Efficacy and safety results were similar to the overall study population. Patients with AD who meet standard disease severity eligibility criteria for systemic therapy may achieve IGA-treatment success with clear/almost clear skin with continuous-use ruxolitinib cream, and maintain long term-disease control with as-needed ruxolitinib cream monotherapy. NCT03745638/NCT03745651.

Assessment of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS™) with modification of the management recommendations for pediatric thyroid nodules.

Thyroid nodules are unusual in children, but when present, they carry a higher risk for malignancy, as compared to adults. Several guidelines have been created to address the risk stratification for malignancy of thyroid nodules in adults, but none has been completely validated in children. A few authors have proposed lowering the size threshold to the American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI-RADS™) management guidelines to decrease missed carcinomas at presentation in children; however, little information is known regarding their accuracy. To assess the performance of proposed modifications of the ACR TI-RADS™ size criteria to guide management decisions in pediatric thyroid nodules and to assess the associated increase in number of fine needle aspiration (FNA) and follow-up exams. This is a retrospective study of children under 18years old who underwent ultrasound assessment of a thyroid nodule at a tertiary care pediatric institution between January 2006 and August 2021. The largest dimension, maximum ACR TI-RADS™ score, and final thyroid nodules' diagnoses were documented. The course of action based on the adult ACR TI-RADS™ and after modifying the size threshold for management recommendations was documented and compared. Statistics included descriptive analysis, weighted Kappa statistics, sensitivity, specificity, accuracy, and positive/negative predictive values of the ACR TI-RADS™ presented with 95% confidence intervals (CI) using either Clopper-Pearson or standard logit methods. Of 116 nodules, 18 (15.5%) were malignant. Most malignant nodules (94.4%, n = 17) were ACRTI-RADS™ 4 and ACRTI-RADS™ 5 categories. Based on the adult ACR TI-RADS™ criteria, 24 (24.5%) benign and 15 (83.3%) malignant nodules would have undergone FNA; 14 (14.3%) benign and 3 (16.7%) malignant nodules would have been followed up; and 60 (61.2%) benign and none of malignant nodules would have been dismissed. Three (16.7%) malignant nodules would not have been recommended FNA at presentation, delaying their diagnoses. By lowering the size-threshold criteria of the ACR TI-RADS™ guidelines, no malignancy would have been missed at presentation, but this also resulted in a higher number of FNA from 24 (24.5%) to 36 (36.7%) and follow-up ultrasound exams from 14 (14.3%) to 62 (63.3%). Applying potential modifications to the ACR TI-RADS™ guideline lowering the size threshold criteria of the thyroid nodule to guide management decisions for pediatric thyroid nodules can lead to early detection of malignant nodules in children, but at the cost of a significantly increased number of biopsies or ultrasound exams. Further tailoring of the guideline with larger multicentric studies is needed, before warranting its acceptance and general use in the pediatric population.

Model adaptive phase space reconstruction.

Phase space reconstruction (PSR) methods allow for the analysis of low-dimensional data with methods from dynamical systems theory, but their application to prediction models, such as those from machine learning (ML), is limited. Therefore, we here present a model adaptive phase space reconstruction (MAPSR) method that unifies the process of PSR with the modeling of the dynamical system. MAPSR is a differentiable PSR based on time-delay embedding and enables ML methods for modeling. The quality of the reconstruction is evaluated by the prediction loss. The discrete-time signal is converted into a continuous-time signal to achieve a loss function, which is differentiable with respect to the embedding delays. The delay vector, which stores all potential embedding delays, is updated along with the trainable parameters of the model to minimize prediction loss. Thus, MAPSR does not rely on any threshold or statistical criterion for determining the dimension and the set of delay values for the embedding process. We apply the MAPSR method to uni- and multivariate time series stemming from chaotic dynamical systems and a turbulent combustor. We find that for the Lorenz system, the model trained with the MAPSR method is able to predict chaotic time series for nearly seven to eight Lyapunov time scales, which is found to be much better compared to other PSR methods [AMI-FNN (average mutual information-false nearest neighbor) and PECUZAL (Pecora-Uzal) methods]. For the univariate time series from the turbulent combustor, the long-term cumulative prediction error of the MAPSR method for the regime of chaos stays between other methods, and for the regime of intermittency, MAPSR outperforms other PSR methods.

Nonlinear Dynamics of a General Stochastic SIR Model with Behavioral and Physical Changes: Analysis and Application to Zoonotic Tuberculosis

This paper presents a comprehensive nonlinear analysis of an innovative stochastic epidemic model that accounts for both behavioral changes and physical discontinuities. Our research begins with the formulation of a perturbed model, integrating two general incidence functions and incorporating a Lévy measure to account for independent jump components. We start by confirming the well-posed nature of the model, ensuring its mathematical soundness and feasibility for further analysis. Following this, we establish a global threshold criterion that serves to distinguish between the eradication and the persistence of an epidemic. This threshold is crucial for understanding the long-term behavior of a disease within a population. To rigorously validate the accuracy of this threshold, we conducted extensive numerical simulations using estimated data on Zoonotic Tuberculosis in Morocco. These simulations provide practical insights and reinforce the theoretical findings of our study. A notable aspect of our approach is its significant advancement over previous works in the literature. Our model not only offers a more comprehensive framework but also identifies optimal conditions under which an epidemic can be controlled or eradicated.

Underwater acoustic signal denoising based on sparse TQWT and wavelet thresholding

The time-varying characteristics of the underwater environment lead to complicated background noise in collected signals. To reduce the negative impact of noise, this paper proposes the tunable Q-factor wavelet transform (TQWT)-basis pursuit (TQWT-BP)-based wavelet thresholding denoising schemes (TQWT-BP-WT). We commence by decomposing the collected signal into multiple subbands upon using TQWT-BP. Then, subbands are divided into signal subbands and noise subbands by applying the component identification criteria. The wavelet thresholding is invoked to denoise the signal subbands, while noise subbands are discarded. To classify the subbands, we design two criteria based on the coefficients threshold and the correlation coefficients, respectively. The coefficients threshold-based criterion determines the subband components by examining the number of coefficients that satisfy the threshold conditions. By comparing the correlation coefficients between the subbands and original signal, as well as between the subbands and the pre-denoised signal, the correlation coefficient-based method distinguishes the subbands, which avoids setting the criterion threshold. In addition, we investigate the influence of different normalized signal amplitudes decomposed by TQWT-BP, and the design of the normalized scale selection approach. Finally, practical simulation results are provided to verify the performance of our proposed schemes compared to other counterparts.

REZILIENT2: Phase 2 study of zipalertinib in patients with advanced non-small cell lung cancer (NSCLC) with exon 20 insertions (ex20ins) and other uncommon epidermal growth factor receptor (EGFR) mutations.

TPS8670 Background: Patients with NSCLC harboring uncommon EGFR mutations, including ex20ins, have limited treatment options. Zipalertinib (CLN-081/TAS6417) is an oral tyrosine kinase inhibitor of EGFR with broad activity against EGFRmutations (including ex20ins) and increased selectivity for ex20ins versus wild-type EGFR. Zipalertinib has shown preclinical activity against a wide spectrum of EGFR ex20ins mutations and other uncommon EGFR mutations. In a phase 1/2a study (REZILIENT1), encouraging antitumor activity and an acceptable safety profile were observed in heavily pretreated patients with EGFRex20ins–mutant NSCLC, leading to ‘Breakthrough Therapy’ designation from the U.S. Food and Drug Administration. The aim of REZILIENT2 is to evaluate the efficacy and safety of zipalertinib in patients with NSCLC harboring EGFRex20ins and other uncommon single or compound EGFR mutations, including patients with brain metastases and leptomeningeal disease (LMD). Methods: In this global, phase 2b, open-label, multicohort study (NCT05967689), adult patients with locally advanced or metastatic NSCLC will be assigned to one of four cohorts depending on prior treatment and type of EGFR mutation: A) patients with EGFR ex20ins mutations who have progressed on or after first-line platinum-based chemotherapy and prior therapy targeting ex20ins (administered together or separately) for advanced disease; B) patients with EGFR ex20ins mutations who have not received prior treatment for advanced disease; C) patients with ex20ins or other uncommon single or compound EGFR mutations and active central nervous system metastases (including LMD) who may or may not have received prior treatment for advanced disease; and D) patients harboring other uncommon non-ex20ins single or compound EGFR mutations who have progressed on or after standard systemic therapy. Patients will receive zipalertinib at a starting dose of 100 mg orally twice daily, which will continue on a 21-day cycle until progression, unacceptable toxicity, or other discontinuation criteria are met. The primary endpoint is investigator-assessed objective response rate per Response Evaluation Criteria in Solid Tumours, version 1.1. Secondary endpoints include disease control rate, duration of response, progression-free survival, overall survival, intracranial efficacy per Response Assessment in Neuro-Oncology Brain Metastases (cohort C), safety and tolerability, and pharmacokinetics. Estimated enrollment is 40 patients per cohort (total 160), with potential expansion to ~100 patients per cohort if predefined threshold criteria of efficacy are met. Enrollment began in July 2023. Clinical trial information: NCT05967689 .

A distributed algorithm with network‐independent step‐size and event‐triggered mechanism for economic dispatch problem

AbstractThe economic dispatch problem (EDP) poses a significant challenge in energy management for modern power systems, particularly as these systems undergo expansion. This growth escalates the demand for communication resources and increases the risk of communication failures. To address this challenge, we propose a distributed algorithm with network‐independent step sizes and an event‐triggered mechanism, which reduces communication requirements and enhances adaptability. Unlike traditional methods, our algorithm uses network‐independent step sizes derived from each agent's local cost functions, thus eliminating the need for detailed network topology knowledge. The theoretical derivation identifies a range of step size values that depend solely on the objective function's strong convexity and the gradient's Lipschitz continuity. Furthermore, the proposed algorithm is shown to achieve a linear convergence rate, assuming the event triggering threshold criteria are met for linear convergence. Numerical experiments further validate the effectiveness and advantages of our proposed distributed algorithm by demonstrating its ability to maintain good convergence characteristics while reducing communication frequency.

Carotid Disease Classification: Impact of the 2021 Intersocietal Accreditation Commission Updated Recommendations vs 2003 Society of Radiologists in Ultrasound Consensus Conference Criteria

Introduction: In 2021, the Intersocietal Accreditation Commission (IAC) introduced modified criteria for carotid duplex interpretation based on peak systolic velocity (PSV) and PSV ratio. The most significant change compared to the 2003 Society of Radiologists in Ultrasound (SRU) criteria involved re-defining the thresholds for <50 and 50% to 69% stenosis ranges. Patients identified in <50% vs 50% to 69% ranges may face different disease severity assignments, variable surveillance protocols, medical management approaches, and recommendations for intervention. Facilities may experience altered payment coverage, issues of staff re-training, and questions from referring physicians regarding patient treatment and disease management expectations. The objective of this study was to assess the impact of re-defining these stenosis ranges using the 2021 IAC criteria vs the SRU criteria. Methods: Anonymized patient data from carotid duplex examinations were collected as part of an internal laboratory quality improvement strategy. These data were analyzed in an electronic database using the IAC and SRU threshold criteria to determine the degree of carotid stenosis. Patients with normal arteries, unilateral studies, or complete occlusions were excluded. Results: Of the 1000 patients considered, 850 met the eligibility criteria. Using PSV: for the right carotid, 242 (28.5%) showed a change and 608 (71.5%) showed no change in stenosis classification; for the left carotid, 228 (27%) showed a change and 622 (73%) showed no change. All changes were a downgrading of disease to <50% stenosis. Using PSV ratio: for the right carotid, re-assignment of 53 (22% of changed, 6% of total cohort); for the left carotid, re-assignment of 48 (21% of changed, 5.6% of total cohort). All changes resulted in re-assignment to the 50% to 69% stenosis category. Conclusions: Implementation of the IAC criteria resulted in patients being re-assigned to lower stenosis categories (27% for PSV and 21% for PSV ratio). The impact of these changes on patient care and facility logistics needs careful consideration.

Commissioning of a novel PET-Linac for biology-guided radiotherapy (BgRT).

Biology-guided radiotherapy (BgRT) is a novel radiotherapy delivery technique that utilizes the tumor itself to guide dynamic delivery of treatment dose to the tumor. The RefleXion X1 system is the first radiotherapy system developed to deliver SCINTIX® BgRT. The X1 is characterized by its split arc design, employing two 90-degree positron emission tomography (PET) arcs to guide therapeutic radiation beams in real time, currently cleared by FDA to treat bone and lung tumors. This study aims to comprehensively evaluate the capabilities of the SCINTIX radiotherapy delivery system by evaluating its sensitivity to changes in PET contrast, its adaptability in the context of patient motion, and its performance across a spectrum of prescription doses. A series of experimental scenarios, both static and dynamic, were designed to assess the SCINTIX BgRT system's performance, including an end-to-end test. These experiments involved a range of factors, including changes in PET contrast, motion, and prescription doses. Measurements were performed using a custom-made ArcCHECK insert which included a 2.2cm spherical target and a c-shape structure that can be filled with a PET tracer with varying concentrations. Sinusoidal and cosine4 motion patterns, simulating patient breathing, was used to test the SCINTIX system's ability to deliver BgRT during motion-induced challenges. Each experiment was evaluated against specific metrics, including Activity Concentration (AC), Normalized Target Signal (NTS), and Biology Tracking Zone (BTZ) bounded dose-volume histogram (bDVH) pass rates. The accuracy of the delivered BgRT doses on ArcCHECK and EBT-XD film were evaluated using gamma 3%/2mm and 3%/3mm analysis. In static scenarios, the X1 system consistently demonstrated precision and robustness in SCINTIX dose delivery. The end-to-end delivery to the spherical target yielded good results, with AC and NTS values surpassing the critical thresholds of 5 kBq/mL and 2, respectively. Furthermore, bDVH analysis consistently confirmed 100% pass rates. These results were reaffirmed in scenarios involving changes in PET contrast, emphasizing the system's ability to adapt to varying PET avidities. Gamma analysis with 3%/2mm (10% dose threshold) criteria consistently achieved pass rates>91.5% for the static tests. In dynamic SCINTIX delivery scenarios, the X1 system exhibited adaptability under conditions of motion. Sinusoidal and cosine4 motion patterns resulted in 3%/3mm gamma pass rates>87%. Moreover, the comparison with gated stereotactic body radiotherapy (SBRT) delivery on a conventional c-arm Linac resulted in 93.9% gamma pass rates and used as comparison to evaluate the interplay effect. The 1cm step shift tests showed low overall gamma pass rates of 60.3% in ArcCHECK measurements, while the doses in the PTV agreed with the plan with 99.9% for 3%/3mm measured with film. The comprehensive evaluation of the X1 radiotherapy delivery system for SCINTIX BgRT demonstrated good agreement for the static tests. The system consistently achieved critical metrics and delivered the BgRT doses per plan. The motion tests demonstrated its ability to co-localize the dose where the PET signal is and deliver acceptable BgRT dose distributions.

Consistent Factors Influence Body Mass Index Thresholds for Total Joint Arthroplasty Across Health-Care Systems: A Qualitative Study.

Body mass index (BMI) thresholds are used as eligibility criteria to reduce complication risk in total joint arthroplasty (TJA). This approach oversimplifies preoperative risk assessment and inadvertently restricts access to effective surgical treatment for osteoarthritis. A prior survey of orthopaedic surgeons in the United States identified complex underlying factors that influence BMI considerations. To understand whether similar factors exist and influence surgeons in a different health-care system setting, we investigated Canadian surgeons' views and use of BMI criterion thresholds for TJA access. A cross-sectional online qualitative survey was conducted with orthopaedic surgeons performing TJA in the Canadian health-care system. Responses were anonymous and questions were open-ended to allow for candid perspectives. Survey data were coded and a systematic process was followed to identify major themes. Findings were compared with U.S. surgeon perspectives. Sixty-nine respondents had a mean age of 49.0 ± 11.4 years (range, 33 to 79 years), with a mean surgical experience duration of 15.7 ± 11.4 years (range, 2 to 50 years). Surgeons reported variable use of BMI thresholds in practice. Twelve interconnected factors that influence BMI considerations were identified: (1) variable evidence interpretation, (2) surgical challenge, (3) surgeon beliefs and biases, (4) hospital differences, (5) access to resources, (6) health system bias, (7) patient health status, (8) patient body fat distribution, (9) patient decisional burden (to lose weight or accept risk), (10) evidence gaps and uncertainties, (11) need for innovation, and (12) societal views. Nine themes matched with findings from U.S. surgeons. Parallel to the United States, complex, interconnected factors influence Canadian orthopaedic surgeons' variable use of BMI restrictions for TJA eligibility. Despite different health-care systems and reimbursement models, similar technical and personal factors were identified. With TJA practice guidelines advising against hard BMI criteria, attention regarding access to resources, surgical training, and innovations to address TJA complexity in patients with large bodies are critically needed. Future advancements in this sphere must balance barrier removal with risk reduction to ensure safe and equitable surgical care. This study may influence surgeon behaviors with regard to hard BMI cutoffs for TJA and encourage critical thought about factors that influence decisions about surgical eligibility for patients with high BMI.

Edge Response and Defect Detectability in Flat Panel Digital Radiography

Defect detectability studies are used in nondestructive testing to ascertain the reliability of the method of inspection. In digital radiography, with the growing prevalence of automation of quality control processes by image processing and machine learning, a threshold detection criterion based on quantifiable data from the digital radiograph could be explored. The use of the parameter contrast-to-noise ratio (CNR) of defect signal as a probability of detection (POD) threshold criterion is explored in this paper. A stainless steel block containing artificial defects of known dimensions and location is radiographed by a flat panel detector, and an empirical POD curve is constructed. Before the POD study, the edge response of the flat panel system is studied to ensure noninterference of adjacent defect signals, gain insights about the lateral spread of the defect signal, and provide information to choose the region of interest for CNR calculation. The effect of noise on the POD using CNR as the threshold criterion is also included in the present study. The use of CNR-based POD models for digital radiography to aid the comparison and development of automatic defect detection models is also discussed.

Enhanced Cardiovascular Assessment in Rats Using a Wireless Data Logger

Study objectives and hypothesis: Cardiovascular assessment in animals can be complicated by signal loss of real-time telemetry. We evaluated the benefits of using a wireless data logger to capture 18 hours of blood pressure (BP) and electrocardiogram (ECG) data. This approach eliminates data loss, simplifies analysis and improves results. Methods: One male Sprague Dawley rat was implanted with a PBTA-L implant (Stellar, TSE Systems) using established procedures to collect BP and ECG. All procedures were approved by the AmplifyBio IACUC. Memory and real-time (RT) BP and ECG were recorded at 500Hz for 18+ hours in the acquisition software (Notocord-hem, Instem) on separate days. ECG RR intervals and BP intervals were compared for memory versus RT recordings. Time-based (RMSSD, SDNN, SDANN) and frequency-based (LF, HF) HRV assessment was performed in 5-minute increments. HRV from ECG vs BP were compared for the memory recording. Data and Results: High quality BP and ECG waveforms were recorded to memory and retrieved into the software with no manual intervention or loss of data. The RT recording included 0.48% signal loss. Interval outliers were removed for HRV assessment using thresholds to limit valid RR/beat intervals. This worked well for BP but was less effective for ECG as there were more erroneous intervals due to movement artifact. Time- and frequency-based HRV parameters were compared for memory vs RT recordings for BP and ECG intervals. HRV from BP showed lower variability for RT vs memory (LF↓24.3%, HR↓6.3%, RMSSD↓0.1%, SDNN↓15.4%, SDANN↓6.1%), while HRV from ECG generally produced higher variability for RT vs memory (LF↑111.8%, HF↑175.1%, RMSSD↑93.9%, SDNN↑16.7%, SDANN↓9.5%). These findings can be explained as follows: BP intervals produced less variability with the RT recording because the long intervals caused by signal loss are distinct and consistently removed by threshold criteria. The lost intervals result in lower HRV. ECG intervals produced more variability with the RT recording because the recordings were 1 week apart, and the later RT recording had more movement artifact on the ECG resulting in inaccurate QRS detection. The erroneous intervals were not as effectively removed by thresholds, resulting in higher HRV. We also compared HRV from the BP and ECG signals in the memory recording. The LF and HF powers were 5.4 and 4.5 times as high respectively for the RR (ECG) vs beat (BP) intervals. The time-based HRV parameters for RMSSD and SDNN were higher by 84% and 14%, while SDANN was very similar with ECG results 2% less than BP results. Conclusions: HRV analysis highlights the benefits of using a wireless data logger to record cardiovascular data. Our assessment demonstrated improvements in the effciency and accuracy of HRV analysis. As a secondary outcome, we demonstrated potential benefits of performing HRV analysis on BP vs ECG signals. None. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Bifurcation analysis and chaos for a double-strains HIV coinfection model with intracellular delays, saturated incidence and Logistic growth

In this paper, a class of virus-to-cell HIV model with intracellular delays, saturated incidence and Logistic growth is proposed to characterize the interaction between two types HIV strains, i.e., wild-type and drug-resistant strains. First, a series of threshold criteria on the locally and globally asymptotic stability of (infection-free, dominant, coexistence) equilibria are discussed based on the basic reproduction number R0. Furthermore, a detailed Hopf bifurcation analysis is performed on the coexistence equilibrium using two delays as bifurcation parameters. We find that the Hopf bifurcations induced by double-strains are evidently different and more complicated than that of single strain, the former switches from stability (periodic branches) to un-stability (chaos) more frequently and earlier than the latter since double-strains would yield more pairs of imaginary roots in the characteristic equations. Meanwhile, the total viral load of double-strains would be higher than that of single-strain as well. The emergence of drug resistance imposes either negative or positive influences on the survival of wild-type strain, which would further facilitate the transmission of HIV.

An image segmentation of adhesive droplets based approach to assess the quality of pesticide spray

Pesticide spray is a widely used chemical control method to minimize biological disasters in the agriculture industry. It is important to evaluate the efficacy and the quality of a pesticide sprayer, however, it cannot be conveniently achieved due to the lack of accessibility to the sprayed droplets and the intensity of the associated work. This paper proposes a novel method, based on an image processing-based approach, to assess the spray quality. The proposed method uses a combination of algorithms and criteria functions; such as, the maximum between-cluster variance algorithm, area threshold criteria, roundness factor, mathematical morphology operations, and the optimized watershed algorithm, to segment and assess the dark blue adhesive droplet images on a water-sensitive paper, placed in the crop field. In this work, three kinds of evaluation experiments are considered: (i) the manual analysis via droplet counting and processing, (ii) the automatic analysis by the commercially available droplet analyzer by Shenzhen DJI Co. Ltd., and (iii) the novel image processing based method introduced in this paper. The experimental results show a better consistency between the introduced novel method and the manual method. The former, however, provides a convenient and rapid way to assess the spray quality. It comes with an assessment algorithm along with an embedded device that provides a hardware view of the spray quality.

A central vein sign in the magnetic resonance diagnosing of multiple sclerosis

Background. Multiple sclerosis (MS) is a chronic autoimmune demyelinating disease, which is characterized by the inevitable disability of patients in the long term, which determines the relevance of this problem. Currently, active improvements are being made in the methods of diagnosing multiple sclerosis, which include the use of the central vein sign in magnetic resonance imaging (MRI) as a neuroimaging biomarker of MS with high sensitivity and specificity.Aim of study. Determination of the possibility of assessing the central vein sign (CVS) according to MRI data as a potential diagnostic biomarker of MS.Object and methods. An open single-center prospective study of brain MR data was conducted in 55 patients with a verified diagnosis of MS (EDSS 1.0-6.5) aged 19 to 72 years. MR-images were obtained on a tomograph with a magnetic field induction force of 3.0 T. Patients underwent MRI of the brain according to the standard protocol: T2-VI, FLAIR, T1-VI (before and after administration of contrast agent), SWI. A comprehensive statistical analysis and evaluation of the obtained MRI data was performed using the Statistica 12 program.Result. During the evaluation of MR-tomograms, all patients with a verified diagnosis in the foci of MS were found to have CVS. In 14.5 % of patients, CVS was detected in 10-30 % of foci, in 61.8 % of patients in 30-60 %, in 23.6 % of patients, from 60 to 95 % was detected. Accordingly, 52.7 % of patients overcame the threshold value of 45 % required for the differential diagnosis of MS from other conditions.Conclusion. The use of CVS in MRI helps to solve the problem of differential diagnosis of MS from other demyelinating diseases when using its threshold criterion – the percentage of foci containing central veins.

Socioeconomic and ethnic disparities associated with access to cochlear implantation for severe-to-profound hearing loss: A multicentre observational study of UK adults.

Patients with severe-to-profound hearing loss may benefit from management with cochlear implants. These patients need a referral to a cochlear implant team for further assessment and possible surgery. The referral pathway may result in varied access to hearing healthcare. This study aimed to explore referral patterns and whether there were any socioeconomic or ethnic associations with the likelihood of referral. The primary outcome was to determine factors influencing referral for implant assessment. The secondary outcome was to identify factors impacting whether healthcare professionals had discussed the option of referral. A multicentre multidisciplinary observational study was conducted in secondary care Otolaryngology and Audiology units in Great Britain. Adults fulfilling NICE (2019) audiometric criteria for implant assessment were identified over a 6-month period between 1 July and 31 December 2021. Patient- and site-specific characteristics were extracted. Multivariable binary logistic regression was employed to compare a range of factors influencing the likelihood of implant discussion and referral including patient-specific (demographics, past medical history, and degree of hearing loss) and site-specific factors (cochlear implant champion and whether the hospital performed implants). Hospitals across all 4 devolved nations of the UK were invited to participate, with data submitted from 36 urban hospitals across England, Scotland, and Wales. Nine hospitals (25%) conducted cochlear implant assessments. The majority of patients lived in England (n = 5,587, 86.2%); the rest lived in Wales (n = 419, 6.5%) and Scotland (n = 233, 3.6%). The mean patient age was 72 ± 19 years (mean ± standard deviation); 54% were male, and 75·3% of participants were white, 6·3% were Asian, 1·5% were black, 0·05% were mixed, and 4·6% were self-defined as a different ethnicity. Of 6,482 submitted patients meeting pure tone audiometric thresholds for cochlear implantation, 311 already had a cochlear implant. Of the remaining 6,171, 35.7% were informed they were eligible for an implant, but only 9.7% were referred for assessment. When adjusted for site- and patient-specific factors, stand-out findings included that adults were less likely to be referred if they lived in more deprived area decile within Indices of Multiple Deprivation (4th (odds ratio (OR): 2·19; 95% confidence interval (CI): [1·31, 3·66]; p = 0·002), 5th (2·02; [1·21, 3·38]; p = 0·05), 6th (2·32; [1·41, 3·83]; p = 0.05), and 8th (2·07; [1·25, 3·42]; p = 0·004)), lived in London (0·40; [0·29, 0·57]; p < 0·001), were male (females 1·52; [1·27, 1·81]; p < 0·001), or were older (0·97; [0·96, 0·97]; p < 0·001). They were less likely to be informed of their potential eligibility if they lived in more deprived areas (4th (1·99; [1·49, 2·66]; p < 0·001), 5th (1·75; [1·31, 2·33], p < 0·001), 6th (1·85; [1·39, 2·45]; p < 0·001), 7th (1·66; [1·25, 2·21]; p < 0·001), and 8th (1·74; [1·31, 2·31]; p < 0·001) deciles), the North of England or London (North 0·74; [0·62, 0·89]; p = 0·001; London 0·44; [0·35, 0·56]; p < 0·001), were of Asian or black ethnic backgrounds compared to white patients (Asian 0·58; [0·43, 0·79]; p < 0·001; black 0·56; [0·34, 0·92]; p = 0·021), were male (females 1·46; [1·31, 1·62]; p < 0·001), or were older (0·98; [0·98, 0·98]; p < 0·001). The study methodology was limited by its observational nature, reliance on accurate documentation of the referring service, and potential underrepresentation of certain demographic groups. The majority of adults meeting pure tone audiometric threshold criteria for cochlear implantation are currently not appropriately referred for assessment. There is scope to target underrepresented patient groups to improve referral rates. Future research should engage stakeholders to explore the reasons behind the disparities. Implementing straightforward measures, such as educational initiatives and automated pop-up tools for immediate identification, can help streamline the referral process.

Multilevel thresholding with divergence measure and improved particle swarm optimization algorithm for crack image segmentation

Crack formation is a common phenomenon in engineering structures, which can cause serious damage to the safety and health of these structures. An important method of ensuring the safety and health of engineered structures is the prompt detection of cracks. Image threshold segmentation based on machine vision is a crucial technology for crack detection. Threshold segmentation can separate the crack area from the background, providing convenience for more accurate measurement and evaluation of the crack condition and location. The segmentation of cracks in complex scenes is a challenging task, and this goal can be achieved by means of multilevel thresholding. The arithmetic-geometric divergence combines the advantages of the arithmetic mean and the geometric mean in probability measures, enabling a more precise capture of the local features of an image in image processing. In this paper, a multilevel thresholding method for crack image segmentation based on the minimum arithmetic-geometric divergence is proposed. To address the issue of time complexity in multilevel thresholding, an enhanced particle swarm optimization algorithm with local stochastic perturbation is proposed. In crack detection, the thresholding criterion function based on the minimum arithmetic-geometric divergence can adaptively determine the thresholds according to the distribution characteristics of pixel values in the image. The proposed enhanced particle swarm optimization algorithm can increase the diversity of candidate solutions and enhance the global convergence performance of the algorithm. The proposed method for crack image segmentation is compared with seven state-of-the-art multilevel thresholding methods based on several metrics, including RMSE, PSNR, SSIM, FSIM, and computation time. The experimental results show that the proposed method outperforms several competing methods in terms of these metrics.

A threshold criterion of stress intensity range in a steel sheet

Fatigue fractures often originate and propagate from geometric discontinuities or material defects in equipment or components. The occurrence and propagation of cracks near the fatigue limit were observed in notched specimens of a steel sheet that simulated this situation, and analyzed using fracture mechanics parameters. The notch caused strain concentration, and local plastic strain arose even at low stress amplitudes. Transgranular fracture occurred, and arrested cracks were observed near the threshold stress amplitude Δσth. The threshold stress intensity range ΔKth had a good power function correlation with the effective notch length aef, but it depended on the length and did not reach a constant value. By identifying and applying the critical power exponent, we proposed a prediction model using the function ΔKthc=Yπ1/2Δσthaef1/κ, which is the critical threshold stress intensity range that has a constant value. κ is equal to 5 for the steel sheet under transverse bending. Since ΔKth c obtained using this critical exponent method does not depend on the crack length, it can be used as a material constant and a failure criterion, and can be applied as a new strength prediction model.

Confirming the attainment of maximal oxygen uptake within special and clinical groups: A systematic review and meta-analysis of cardiopulmonary exercise test and verification phase protocols.

A plateau in oxygen uptake ([Formula: see text]) during an incremental cardiopulmonary exercise test (CPET) to volitional exhaustion appears less likely to occur in special and clinical populations. Secondary maximal oxygen uptake ([Formula: see text]) criteria have been shown to commonly underestimate the actual [Formula: see text]. The verification phase protocol might determine the occurrence of 'true' [Formula: see text] in these populations. The primary aim of the current study was to systematically review and provide a meta-analysis on the suitability of the verification phase for confirming 'true' [Formula: see text] in special and clinical groups. Secondary aims were to explore the applicability of the verification phase according to specific participant characteristics and investigate which test protocols and procedures minimise the differences between the highest [Formula: see text] values attained in the CPET and verification phase. Electronic databases (PubMed, Web of Science, SPORTDiscus, Scopus, and EMBASE) were searched using specific search strategies and relevant data were extracted from primary studies. Studies meeting inclusion criteria were systematically reviewed. Meta-analysis techniques were applied to quantify weighted mean differences (standard deviations) in peak [Formula: see text] from a CPET and a verification phase within study groups using random-effects models. Subgroup analyses investigated the differences in [Formula: see text] according to individual characteristics and test protocols. The methodological quality of the included primary studies was assessed using a modified Downs and Black checklist to obtain a level of evidence. Participant-level [Formula: see text] data were analysed according to the threshold criteria reported by the studies or the inherent measurement error of the metabolic analysers and displayed as Bland-Altman plots. Forty-three studies were included in the systematic review, whilst 30 presented quantitative information for meta-analysis. Within the 30 studies, the highest mean [Formula: see text] values attained in the CPET and verification phase protocols were similar (mean difference = -0.00 [95% confidence intervals, CI = -0.03 to 0.03] L·min-1, p = 0.87; level of evidence, LoE: strong). The specific clinical groups with sufficient primary studies to be meta-analysed showed a similar [Formula: see text] between the CPET and verification phase (p > 0.05, LoE: limited to strong). Across all 30 studies, [Formula: see text] was not affected by differences in test protocols (p > 0.05; LoE: moderate to strong). Only 23 (53.5%) of the 43 reviewed studies reported how many participants achieved a lower, equal, or higher [Formula: see text] value in the verification phase versus the CPET or reported or supplied participant-level [Formula: see text] data for this information to be obtained. The percentage of participants that achieved a lower, equal, or higher [Formula: see text] value in the verification phase was highly variable across studies (e.g. the percentage that achieved a higher [Formula: see text] in the verification phase ranged from 0% to 88.9%). Group-level verification phase data appear useful for confirming a specific CPET protocol likely elicited [Formula: see text], or a reproducible [Formula: see text], for a given special or clinical group. Participant-level data might be useful for confirming whether specific participants have likely elicited [Formula: see text], or a reproducible [Formula: see text], however, more research reporting participant-level data is required before evidence-based guidelines can be given. PROSPERO (CRD42021247658) https://www.crd.york.ac.uk/prospero.

Graph neural network-based anomaly detection for river network systems

Background Water is the lifeblood of river networks, and its quality plays a crucial role in sustaining both aquatic ecosystems and human societies. Real-time monitoring of water quality is increasingly reliant on in-situ sensor technology. Anomaly detection is crucial for identifying erroneous patterns in sensor data, but can be a challenging task due to the complexity and variability of the data, even under typical conditions. This paper presents a solution to the challenging task of anomaly detection for river network sensor data, which is essential for accurate and continuous monitoring. Methods We use a graph neural network model, the recently proposed Graph Deviation Network (GDN), which employs graph attention-based forecasting to capture the complex spatio-temporal relationships between sensors. We propose an alternate anomaly threshold criteria for the model, GDN+, based on the learned graph. To evaluate the model’s efficacy, we introduce new benchmarking simulation experiments with highly-sophisticated dependency structures and subsequence anomalies of various types. We also introduce software called gnnad. Results We further examine the strengths and weaknesses of this baseline approach, GDN, in comparison to other benchmarking methods on complex real-world river network data. Conclusions Findings suggest that GDN+ outperforms the baseline approach in high-dimensional data, while also providing improved interpretability.