Tag: pubmed

Med Phys. 2024 Oct 24. doi: 10.1002/mp.17473. Online ahead of print.

ABSTRACT

BACKGROUND: The findings of the 2023 AAPM Grand Challenge on Deep Generative Modeling for Learning Medical Image Statistics are reported in this Special Report.

PURPOSE: The goal of this challenge was to promote the development of deep generative models for medical imaging and to emphasize the need for their domain-relevant assessments via the analysis of relevant image statistics.

METHODS: As part of this Grand Challenge, a common training dataset and an evaluation procedure was developed for benchmarking deep generative models for medical image synthesis. To create the training dataset, an established 3D virtual breast phantom was adapted. The resulting dataset comprised about 108 000 images of size 512 $\times$ 512. For the evaluation of submissions to the Challenge, an ensemble of 10 000 DGM-generated images from each submission was employed. The evaluation procedure consisted of two stages. In the first stage, a preliminary check for memorization and image quality (via the Fréchet Inception Distance [FID]) was performed. Submissions that passed the first stage were then evaluated for the reproducibility of image statistics corresponding to several feature families including texture, morphology, image moments, fractal statistics, and skeleton statistics. A summary measure in this feature space was employed to rank the submissions. Additional analyses of submissions was performed to assess DGM performance specific to individual feature families, the four classes in the training data, and also to identify various artifacts.

RESULTS: Fifty-eight submissions from 12 unique users were received for this Challenge. Out of these 12 submissions, 9 submissions passed the first stage of evaluation and were eligible for ranking. The top-ranked submission employed a conditional latent diffusion model, whereas the joint runners-up employed a generative adversarial network, followed by another network for image superresolution. In general, we observed that the overall ranking of the top 9 submissions according to our evaluation method (i) did not match the FID-based ranking, and (ii) differed with respect to individual feature families. Another important finding from our additional analyses was that different DGMs demonstrated similar kinds of artifacts.

CONCLUSIONS: This Grand Challenge highlighted the need for domain-specific evaluation to further DGM design as well as deployment. It also demonstrated that the specification of a DGM may differ depending on its intended use.

PMID:39447007 | DOI:10.1002/mp.17473

JBJS Rev. 2024 Oct 24;12(10). doi: 10.2106/JBJS.RVW.24.00149. eCollection 2024 Oct 1.

ABSTRACT

BACKGROUND: Seasonal trends in hospitalization for childhood bone and joint infection (BJI) are reported inconsistently. True seasonal variation would suggest an element of disease risk from environmental factors. This review evaluates all reported seasonal variations in childhood BJI, with additional analysis of seasonal trends for diseases secondary to Kingella kingae.

METHODS: A systematic review of the literature was undertaken from January 1, 1980, to August 1, 2024. Data were extracted on the hospitalization rate by season and/or month. Pathogen-specific studies for BJI secondary to K. kingae were examined separately.

RESULTS: Twenty studies met inclusion criteria encompassing 35,279 cases of childhood BJI. Most studies reported seasonal variation (n = 15, 75%). Eight studies specifically considered disease secondary to K. kingae, and all reported more frequent hospitalization in autumn and/or winter. This is in keeping with the role of respiratory pathogens and seasonal viruses in disease etiology for K. kingae BJI. Findings from other studies on the seasonality of childhood BJI were inconsistent. There were reported seasonal peaks in autumn/winter (4 studies), summer/spring (5 studies), or no variation (5 studies). Where microbiologic data were available, Staphylococcus aureus was the primary pathogen. The quality assessment demonstrated confounding and heterogeneous inclusion criteria affecting the seasonal analysis.

CONCLUSION: For childhood BJI caused by K. kingae, there appears to be a higher risk of hospitalization in autumn and/or winter months. This may relate to the seasonal circulation of respiratory viruses. There is currently insufficient evidence to support other forms of seasonal variation. Reported findings are likely affected by regional disease and pathogen characteristics.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:39446985 | DOI:10.2106/JBJS.RVW.24.00149

Clin Exp Dermatol. 2024 Oct 24:llae460. doi: 10.1093/ced/llae460. Online ahead of print.

ABSTRACT

Basal cell carcinomas (BCCs) are slow growing keratinocyte tumours with limited literature reporting the natural history of untreated BCCs. This study evaluated the natural progression and patient outcomes of BCCs whilst awaiting surgical intervention. Only patients with histologically proven BCCs were included in the data collection. Retrospective data analysis was performed on 55 patients (total of 70 lesions) and showed a statistically significant correlation between average growth of BCCs and time waiting for a procedure. Twenty percent of the cases had a larger procedure than originally planned at the time of booking. The top three symptoms reported include itching (39.4%), crusting (36.4%) and bleeding (30.3%). In conclusion, we reported a positive relationship between BCC growth and length of time from initial presentation to surgical treatment where patients often ended up with more symptoms, larger and complex surgical procedure than originally planned especially on the head and neck.

PMID:39446979 | DOI:10.1093/ced/llae460

PLoS One. 2024 Oct 24;19(10):e0304932. doi: 10.1371/journal.pone.0304932. eCollection 2024.

ABSTRACT

This study investigates the technology acceptance of a proposed multimodal wearable sensing framework, named mSense, within the context of non-invasive real-time neurofeedback for student stress and anxiety management. The COVID-19 pandemic has intensified mental health challenges, particularly for students. Non-invasive techniques, such as wearable biofeedback and neurofeedback devices, are suggested as potential solutions. To explore the acceptance and intention to use such innovative devices, this research applies the Technology Acceptance Model (TAM), based on the co-creation approach. An online survey was conducted with 106 participants, including higher education students, health researchers, medical professionals, and software developers. The TAM key constructs (usage attitude, perceived usefulness, perceived ease of use, and intention to use) were validated through statistical analysis, including Partial Least Square-Structural Equation Modeling. Additionally, qualitative analysis of open-ended survey responses was performed. Results confirm the acceptance of the mSense framework for neurofeedback-based stress and anxiety management. The study contributes valuable insights into factors influencing user intention to use multimodal wearable devices in educational settings. The findings have theoretical implications for technology acceptance and practical implications for extending the usage of innovative sensors in clinical and educational environments, thereby supporting both physical and mental health.

PMID:39446926 | DOI:10.1371/journal.pone.0304932

PLoS One. 2024 Oct 24;19(10):e0312498. doi: 10.1371/journal.pone.0312498. eCollection 2024.

ABSTRACT

BACKGROUND/OBJECTIVES: Frailty is a common condition among older adults and is associated with an increased risk of adverse health outcomes, including mortality, disability, dysmobility, falls, and hospitalization. In patients with atrial fibrillation (AF), these risks are further exacerbated. However, evidence linking AF and frailty, particularly in the South American context, is limited. This study aimed to assess frailty and other geriatric conditions in older outpatients with atrial fibrillation in a resource-limited setting in Lima, Peru.

METHODS: In this cross-sectional study, we included adults aged 60 years and older diagnosed with atrial fibrillation who were attending outpatient check-ups. Patients who were hospitalized, receiving chemotherapy induction, or presenting with acute infections or exacerbations were excluded. Standardized questionnaires were used to assess frailty, cognitive impairment, and functional dependence. Statistical analysis was performed using R Studio version 4.3.1, with a significance level set at p < 0.05.

RESULTS: Among the 200 patients who agreed to participate (mean age 74.76 ± 8.42 years, 41% females), 28.5% exhibited frailty, and 46.5% were classified as prefrail. Frailty and prefrailty were significantly associated with older age (p<0.01), female gender (p = 0.01), illiteracy (p<0.01), heart failure (p<0.01), falls (p<0.05), cognitive impairment (p<0.01), and functional dependence (p<0.01). Multivariate analysis revealed significant associations between frailty and cognitive impairment (p<0.05), frailty and functional dependence (p<0.05), and cognitive impairment and functional dependence (p<0.05).

CONCLUSIONS: One-third of older outpatients with atrial fibrillation were identified as frail, while half were classified as prefrail. In this population, frailty frequently coexists with cognitive impairment and functional dependence, highlighting the need for timely screening and the implementation of evidence-based interventions for individuals with atrial fibrillation in resource-limited settings.

PMID:39446924 | DOI:10.1371/journal.pone.0312498

Mod Br Hist. 2024 May 31;35(2):164-179. doi: 10.1093/tcbh/hwae033.

ABSTRACT

During the Second World War and the austerity period that followed it, the British government operated clothes rationing as a welfare policy. Its official aim was to ensure that all citizens had equal access to essential clothing. Despite being associated with the principle of ‘fair shares’, rationing did not work well for large-bodied consumers. Government agents’ assumptions about citizens’ bodies generated a rationing scheme that overlooked large bodies. As a result, rationing regulations and economic controls amplified the normalizing impulses of mass production, creating a constant shortage of ready-made large garments and a market in which purchasing power and access to goods depended on body size. Struggling to navigate this market, consumers attempted to hold the government accountable for its declarations of equality. Tracing this issue in government records and in local, national, and trade press, this article discusses how the conflicting motivations of state, trade, and citizens shaped rationing in a way that prioritized the culturally and statistically ‘normal’ and reflects on what mass welfare meant for citizens with ‘abnormal’ needs.

PMID:39446474 | DOI:10.1093/tcbh/hwae033

Pflege. 2024 Oct 24. doi: 10.1024/1012-5302/a001018. Online ahead of print.

ABSTRACT

On the effectiveness of a new advisory service for parents of children in need of care: a controlled study Abstract: Background: Families with children in need of care are exposed to great stress. This results in risks that often lead to a poor living and care situation for families. To support them, an innovative regionally anchored support service is being developed by so-called Family Health Partners (FGP) as part of the NEST research project. Aim/Objective: The primary endpoint of the study is the quality of life of the families. Secondary outcomes are resilience factors and associated measures as well as access to care services. Methods: The effectiveness of the FGP will be tested in a controlled study with four measurement times (baseline, after 6, 12 and 18 months) between January 2022 and April 2024. A total of 204 families with children in need of care were recruited for an intervention and control group. Multilevel models are used to analyze the longitudinal data. Results: Between T0 and T1 there are statistically significant improvements in the intervention group, especially in daily and social stress in the family, in mental health and resilience. In addition, knowledge about general benefit rights as well as specific support and relief offers for caring parents has increased. Conclusions: The results of the first two measurement times indicate that a positive change in quality of life, resilience and health literacy can be achieved through the FGP.

PMID:39446470 | DOI:10.1024/1012-5302/a001018

J Vasc Access. 2024 Oct 24:11297298241291695. doi: 10.1177/11297298241291695. Online ahead of print.

ABSTRACT

INTRODUCTION: Optimizing vascular access for hemodialysis in end-stage kidney disease is crucial. While arteriovenous fistulas (AVFs) are preferred for better patency and fewer complications, many patients require alternatives options like arteriovenous grafts (AVGs) due to anatomical constraints. This study compares outcomes between elbow and upper arm (UA) basilic veins for forearm loop AVGs, highlighting the potential benefits of the UA basilic vein to improve patency and feasibility in patients with poor elbow veins through retrospective analysis.

METHODS: This retrospective study analyzed 59 limbs of patients who underwent forearm loop AVG formation from January 2018 to June 2022. Elbow veins (basilic, median cubital, brachial) and UA basilic veins were evaluated for suitability using duplex ultrasonography. AVG decisions were based on patient age, health, and vein diameter (⩾2.3 mm). Statistical analyses compared baseline characteristics and evaluated primary and secondary patency rates at 12 and 18 months using Pearson’s chi-square, Student’s t-test, Kaplan-Meier survival analysis, and the Log-rank test.

RESULTS: Thirty-six patients had elbow anastomosis, while 23 had UA anastomosis for forearm loop AVG. The elbow group had a higher male proportion (72.7% vs 34.7% in UA, p = 0.005) and larger elbow vein diameters (2.52 ± 0.19 mm vs 2.16 ± 0.21 mm in UA, p < 0.001). Primary patency rates at 12 months were 72.7% for elbow and 56.2% for UA; at 18 months, 59.4% and 25.5%, respectively (p = 0.376). Secondary patency rates at 12 months were 75.7% for elbow and 62.2% for UA; at 18 months, 67.8% and 33.9%, respectively (p = 0.238).

CONCLUSION: The primary and secondary patency rates of forearm loop AVG with UA basilic vein anastomosis were not inferior to those with elbow veins anastomosis. UA basilic vein can be a feasible alternative for creating forearm loop AVG when elbow veins are not suitable.

PMID:39446468 | DOI:10.1177/11297298241291695

JMIR Res Protoc. 2024 Oct 24;13:e60496. doi: 10.2196/60496.

ABSTRACT

BACKGROUND: Connected sensor technologies can capture raw data and analyze them using advanced statistical methods such as machine learning or artificial intelligence to generate interpretable behavioral or physiological outcomes. Previous research conducted on connected sensor technologies has focused on design, development, and validation. Published review studies have either summarized general technological solutions to address specific behaviors such as physical activity or focused on remote monitoring solutions in specific patient populations.

OBJECTIVE: This study aimed to map research that focused on using connected sensor technologies to augment rehabilitation services by informing care decisions.

METHODS: The Population, Concept, and Context framework will be used to define inclusion criteria. Relevant articles published between 2008 to the present will be included if (1) the study enrolled adults (population), (2) the intervention used at least one connected sensor technology and involved data transfer to a clinician so that the data could be used to inform the intervention (concept), and (3) the intervention was within the scope of rehabilitation (context). An initial search strategy will be built in Embase; peer reviewed; and then translated to Ovid MEDLINE ALL, Web of Science Core Collection, and CINAHL. Duplicates will be removed prior to screening articles for inclusion. Two independent reviewers will screen articles in 2 stages: title/abstract and full text. Discrepancies will be resolved through group discussion. Data from eligible articles relevant to population, concept, and context will be extracted. Descriptive statistics will be used to report findings, and relevant outcomes will include the type and frequency of connected sensor used and method of data sharing. Additional details will be narratively summarized and displayed in tables and figures. Key partners will review results to enhance interpretation and trustworthiness.

RESULTS: We conducted initial searches to refine the search strategy in February 2024. The results of this scoping review are expected in October 2024.

CONCLUSIONS: Results from the scoping review will identify critical areas of inquiry to advance the field of technology-augmented rehabilitation. Results will also support the development of a longitudinal model to support long-term health outcomes.

TRIAL REGISTRATION: Open Science Framework jys53; https://osf.io/jys53.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/60496.

PMID:39446418 | DOI:10.2196/60496

JAMA Ophthalmol. 2024 Oct 24. doi: 10.1001/jamaophthalmol.2024.4395. Online ahead of print.

ABSTRACT

IMPORTANCE: Since fibroblast growth factor receptor inhibitors (FGFRi) are used for treatment of intrahepatic cholangiocarcinoma (iCCA), understanding potential complications following longer-term use in clinical practice settings is warranted. This study describes cataract formation or progression as a complication of FGFRi use for the treatment of iCCA, even after treatment discontinuation.

OBJECTIVE: To describe cases of cataract formation or worsening in patients with iCCA treated with FGFRi and to characterize the ophthalmologic features, risk factors, and outcomes for FGFRi-associated cataracts.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective case series study used data from patients with iCCA harboring FGFR2 aberrations who received FGFRi in clinical trials or as standard therapy from the University of California, San Francisco, Hepatobiliary Tissue Bank and Registry. Data were collected from patient visits between February 2015 and October 2021, and this retrospective investigation was conducted from September 6, 2022, to May 4, 2023. Data analysis was conducted from May 5, 2023, to September 6, 2023.

EXPOSURE: Use of an FGFRi for the treatment of iCCA.

MAIN OUTCOMES AND MEASURES: The primary outcome was designated as development of a new or worsening cataract after FGFRi initiation. Statistical analysis for the association between cataract formation and clinical covariates was performed using unpaired t tests and Fisher exact tests. A single bivariate logistic regression model was used to examine total duration of FGFRi therapy and age at the conclusion of FGFRi therapy as predictors of cataract development.

RESULTS: A total of 18 patients were included in the study; median (range) patient age was 54 (27-81) years, and 13 patients (72%) were female. Nine patients (50%) developed a cataract or had cataract progression in at least 1 eye after initiation of FGFRi. Of 17 eyes with cataract, 8 eyes (47%) required cataract surgery. One patient rapidly developed a cataract associated with phacomorphic glaucoma, which required urgent surgery. The median (range) time to cataract onset or worsening from initiation of FGFRi was approximately 18 (1-23) months. Five of 9 patients (56%) who developed cataracts or had cataract progression were diagnosed with new or worsening cataracts after discontinuation of FGFRi. Patients who developed cataracts had longer median (range) duration of FGFRi treatment compared with patients who did not develop cataracts (13 months [2-26] vs 5 months [1-11]; odds ratio, 1.01; 95% CI, 1.00-1.02; P = .02).

CONCLUSIONS AND RELEVANCE: While this retrospective case series study cannot prove cause and effect conclusively due to the study design, study results highlight cataract formation or progression as a potential adverse effect of FGFRi therapy, supporting consideration of periodic eye examinations in patients who have received this treatment.

PMID:39446357 | DOI:10.1001/jamaophthalmol.2024.4395