Visual Assessment of Phony Peach Disease: Evaluating Rater Accuracy and Reliability

Phony peach disease (PPD), found predominantly in central and southern Georgia, is a re-emerging disease caused by Xylella fastidiosa (Xf) subsp. multiplex. Accurate detection and rapid removal of symptomatic trees are crucial to effective disease management. Currently, peach producers rely solely on visual identification of symptoms to confirm PPD, which can be ambiguous if early in development. We compared visual assessment to quantitative PCR (qPCR) for detecting Xf in 'Julyprince' in 2019 and 2020 (JP2019 and JP2020) and in 'Scarletprince' in 2020 (SP2020). With no prior knowledge of qPCR results, all trees in each orchard were assessed by a cohort of five experienced and five inexperienced raters in the morning and afternoon. Visual identification accuracy of PPD was variable, but experienced raters were more accurate when identifying PPD trees. In JP2019, the mean rater accuracy for experienced and inexperienced raters was 0.882 and 0.805, respectively. For JP2020, the mean rater accuracy for experienced and inexperienced raters was 0.914 and 0.816, respectively. For SP2020, the mean rater accuracy for experienced and inexperienced raters was 0.898 and 0.807, respectively. All raters had false positive (FP) and false negative (FN) observations, but experienced raters had significantly lower FN rates compared with the inexperienced group. Almost all raters overestimated the incidence of PPD in the orchards. Reliability of visual assessments was demonstrated as moderate to good, regardless of experience. Further research is needed to develop accurate and reliable methods of detection to aid management of PPD as both FPs and FNs are costly to peach production.

Smartphone Thermal Imaging for Preoperative Perforator Mapping in Perforator Based Flaps

OBJECTIVE

To determine the diagnostic accuracy of smartphone thermal imaging for preoperative perforator mapping in perforator-based flaps, taking visual inspection as gold standard.

METHODOLOGY

It was a cross-validation study conducted at the Department of Plastic Surgery, Dr. Ruth K. Pfau Civil Hospital, Karachi, Pakistan, from August 2022 to January 2023. All adult patients aged 18 to 40 years of either gender undergoing perforator flap surgery were included. Each patient followed the same treatment regimen, which involved the preoperative identification of the perforator location using the FLIR One camera. Subsequently, confirmation was achieved during the surgical procedure through visual inspection. A two-by two table was used to calculate sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy.

RESULTS

The mean age of the patients was 30.10±6.87 years, ranging from 18 to 40 years. Most of the patients were males (58.7%), and 41.3% were females. Almost 80.4% were pedicle flaps, and 19.6% were free flaps. The accuracy of thermal imaging was found to be 83.2%, with a sensitivity of 84.3%, a specificity of 80%, a PPV of 92.9%, and a NPV of 62.2%, respectively.

CONCLUSION

Smartphone-based thermal imaging is useful for the diagnosis of perforators and has high sensitivity and specificity.

Measuring recognition visual acuity in young children - testability with the Waterloo Differential Acuity Test (WatDAT)

CLINICAL RELEVANCE

Visual acuity measurement is important for the detection and monitoring of eye disorders. Developing accurate and sensitive visual acuity tests suitable for young children is therefore desirable.

BACKGROUND

Recognition or form visual acuity (VA), which is measured with matching in children aged 3 years and up, is more sensitive for detecting visual deficits compared to resolution VA. The Waterloo Differential Acuity Test (WatDAT) is a proposed recognition VA test using the concept of identifying the "odd one out" among distractors. The WatDAT is expected to be cognitively easier than matching tests and therefore may be used in younger children. The purpose of this study is to investigate the testability of the WatDAT paradigm in children aged 12-36 months, and to determine the optimum format and number of distractors.

METHODS

Fifty-one typically-developing children aged 12-36 months participated in the study. Data for Patti Pics (PP) and Face targets (FT) were collected for formats with 3, 4 and 5 distractors. The targets were presented binocularly on a computer touch screen at 30 cm. The task was to touch the face among identical non-faces or a house among circles. Following initial training, there were 5 presentations for each distractor format. Testability was defined as correctly identifying at least 4/5 presentations and was also determined for uncrowded PP symbols using matching.

RESULTS

Of participants aged 18-36 months, 87% could perform the WatDAT PP targets with 3 distractors compared to 68% for the FT, while 48% could perform matching with PP. The testability for FT increased to 85% for children ≥22 months. Younger children showed lower testability. For the 3 distractor format, PP targets gave 9% testability in children 12 to <18 months, and FT gave a testability of 16% in children 12 to <22 months.

CONCLUSION

WatDAT testability is higher than matching VA tests. This indicates that the newly developed WatDAT has potential for measuring recognition VA in children 18 months and older.

Feasibility evaluation of middle-phase 18F-florbetaben positron emission tomography imaging using centiloid quantification and visual assessment

Background

18F-florbetaben (FBB) positron emission tomography (PET) scan has been widely used in research and routine clinical practice. Most studies used late-phase (scanning from 90 to 110 min after injection) FBB scans to generate beta-amyloid accumulation data. The feasibility of middle-phase scan is seldom discussed. Using the middle-phase data can shorten the patients' waiting between the injection and scan, and hospital can acquire more flexible schedule of routine scan.

Methods

Paired middle-phase (60-80 min) FBB scans and standard (90-110 min) FBB scans were obtained from 27 subjects (12 neurodegenerative dementia, 8 mild cognitive impairment, 3 normal control, and 4 patients not suffering from neurodegenerative dementia). Standardized uptake value ratios (SUVRs) were calculated and converted to centiloid (CL) scale to investigate the impact on image quantification. CL pipeline validation were performed to build an equation converting the middle-phase data into equivalent standard scans. Cohen's kappa of binary interpretation and brain amyloid plaque load (BAPL) score were also used to evaluate the intrareader agreement of the FBB image from the two protocols.

Results

The middle-phase FBB SUVR showed an excellent correlation, which provided a linear regression equation of SUVRFBB60-80 = 0.88 × SUVRFBB90-110 + 0.07, with R2=0.98. The slope of the equation indicated that there was bias between the middle and standard acquisition. This can be converted into the CL scale using CL = 174.68 × SUVR - 166.39. Cohen's kappa of binary interpretation and BAPL score were 1.0 (P<0.0001).

Conclusions

Our findings indicate that the middle-phase FBB protocol is feasible in clinical applications for scans that are at either end of beta-amyloid spectrum, which provides comparable semiquantitative results to standard scan. Patient's waiting time between the injection and scan can be shortened.

A Novel Method for Quantifying Plant Morphological Characteristics Using Normal Vectors and Local Curvature Data via 3D Modelling-A Case Study in Leaf Lettuce

Three-dimensional measurement is a high-throughput method that can record a large amount of information. Three-dimensional modelling of plants has the possibility to not only automate dimensional measurement, but to also enable visual assessment to be quantified, eliminating ambiguity in human judgment. In this study, we have developed new methods that could be used for the morphological analysis of plants from the information contained in 3D data. Specifically, we investigated characteristics that can be measured by scale (dimension) and/or visual assessment by humans. The latter is particularly novel in this paper. The characteristics that can be measured on a scale-related dimension were tested based on the bounding box, convex hull, column solid, and voxel. Furthermore, for characteristics that can be evaluated by visual assessment, we propose a new method using normal vectors and local curvature (LC) data. For these examinations, we used our highly accurate all-around 3D plant modelling system. The coefficient of determination between manual measurements and the scale-related methods were all above 0.9. Furthermore, the differences in LC calculated from the normal vector data allowed us to visualise and quantify the concavity and convexity of leaves. This technique revealed that there were differences in the time point at which leaf blistering began to develop among the varieties. The precise 3D model made it possible to perform quantitative measurements of lettuce size and morphological characteristics. In addition, the newly proposed LC-based analysis method made it possible to quantify the characteristics that rely on visual assessment. This research paper was able to demonstrate the following possibilities as outcomes: (1) the automation of conventional manual measurements, and (2) the elimination of variability caused by human subjectivity, thereby rendering evaluations by skilled experts unnecessary.

Development of a method for evaluating skin dullness: A mathematical model explaining dullness by the color, optical properties, and microtopography of the skin

BACKGROUND

Skin dullness has long been a major concern of Japanese women. It is usually evaluated and judged visually by experts. Although several factors are recognized to play a role, it is unclear to what extent such physiological characteristics contribute to skin dullness. The purpose of this study is to establish an objective method for evaluation, which will assist in developing cosmetics products targeting skin dullness.

METHODS

We conducted a skin measurement study on 50 Japanese women in their 30-50s, where skin dullness was visually assessed by a group of experts to obtain an average dullness score, and several skin parameters were obtained. We then developed a regression model that explains the visual assessment score using these physiological parameters.

RESULTS

The results of partial least squares analysis of the dullness perception and physiological characteristics showed that skin dullness can be defined by colorimetric, optical, and skin surface microtopography parameters. Additionally, the contribution of each parameter to the model was determined. Our results suggest that dullness perception is highly affected by the melanin content and yellowness of the skin, followed by skin reddishness, roughness, and translucency score, whereas glossiness has less effect. Strikingly, the contribution ratio of each parameter varied among age groups. Furthermore, we confirmed that the predicted value of skin dullness increases with age.

CONCLUSION

Our results will help the design of cosmetics targeting factors specific to age groups in developing effective solutions for skin dullness.

Nigrosome 1 visibility and its association with nigrostriatal dopaminergic loss in Parkinson's disease

BACKGROUND

Nigrosome 1 (NG1), a small cluster of dopaminergic cells in the substantia nigra and visible in the susceptibility map weighted MR image (SMwI), is severely affected in Parkinson's disease (PD). However, the degree of nigrostriatal degeneration according to the visibility of NG1 has not yet been well elucidated.

METHODS

We consecutively recruited 138 PD and 78 non-neurodegenerative disease (non-ND) patients, who underwent both ¹⁸ F-FP-CIT PET and SMwI. Three neurologists and one radiologist evaluated the visibility of NG1 in SMwI. The participants were thereby grouped into the visible, intermediate, and non-visible groups. Nigrostriatal dopaminergic input was calculated using the specific binding ratio (SBR) of the ¹⁸ F-FP-CIT PET. We determined the threshold of regional SBR for discriminating NG1 visibility and the probability for NG1 visibility according to regional SBR.

RESULTS

Visual rating of NG1 showed excellent interobserver agreements as well as high sensitivity and specificity to differentiate the PD group from the non-ND group. NG1 was visible in seven patients (5.1%) in the PD group, who had relatively short disease duration or less severe loss of striatal dopamine. The threshold of putaminal SBR reduction on the more affected side for the disappearance of NG1 was 45.5%, and the probability for NG1 visibility dropped to 50% after the reduction of putaminal SBR to 41% from the normal mean.

CONCLUSIONS

Almost half loss of nigrostriatal dopaminergic input is required to dissipate the hyperintensity of NG1 on SMwI, suggesting its utility in diagnosing PD only after the onset of the motor symptoms.

Comparison between Visual Assessment and Longitudinal Strain during Dobutamine Stress Echocardiography

Background

The relationship between visual assessment and longitudinal strain during dobutamine stress echocardiography (DSE) remains poorly investigated. This study assessed wall motion segments visually graded as normokinetic, hypokinetic, and akinetic at baseline and the peak of DSE and compared with longitudinal strain between segments with and without induced impaired contractility and improved contractility during DSE.

Methods

This study included 112 patients examined by DSE, consisting of 58 patients referred for diagnostic study and 54 patients referred for viability study. Regional left ventricular (LV) contractility was assessed visually and longitudinal strain was measured using echocardiography transthoracic.

Results

At baseline, the strain of LV segments was -16.33 ± 6.26 in visually normokinetic, 13.05 ± 6.44 in visually hypokinetic, and -8.46 ± 5.69 in visually akinetic segments. During peak dose, the strain of LV segments was -15.37 ± 6.89 in visually normokinetic, -11.37 ± 5.11 in visually hypokinetic, and -7.37 ± 3.92 in visually akinetic segments. In segments with visually observed impaired contractility, the median longitudinal strain was significantly lower than in segments without impaired contractility. For segments with visually observed improved contractility, the median longitudinal strain was significantly higher than for segments without improved contractility. In diagnostic study, sensitivity of visual assessment for absolute decrease of >2% longitudinal strain was 77%, respectively. In the viability study, the sensitivity was 82% for an absolute decrease of ≥2% longitudinal strain.

Conclusions

There is good association between strain analysis value and visually assessed wall motion contractility.

Evaluation of feedback methods for improved detection of hindlimb lameness in horses among riding instructors and trainers

Lameness, a wellknown issue in sport horses, impedes performance and impairs welfare. Early detection of lameness is essential for horses to receive needed treatment, but detection of hindlimb lameness is challenging. Riding instructors and trainers observe horses in motion in their daily work and could contribute to more efficient lameness detection. In this cross-sectional and prospective study, we evaluated the ability of riding instructors and trainers to assess hindlimb lameness. We also evaluated different feedback methods for improved lameness detection. For the cross-sectional part, n = 64 riding instructors and trainers of varying level and n = 23 high-level trainers were shown 13 videos of trotting horses, lameness degree: 0–3.5 (test 1) and tasked with classifying the horses as sound, left hindlimb lame, or right hindlimb lame. For the prospective part, the riding instructors and trainers of varying levels were randomly allocated to three different groups (a, b, c) and given 14 days of feedback-based, computer-aided training in identifying hindlimb lameness, where they assessed 13 videos (of which three were repeated from test 1) of horses trotting in a straight line. Participants in groups a-c received different feedback after each video (group a: correct answer and re-viewing of video at full and 65% speed; group b: correct answer, re-viewing of video at full and 65% speed, narrator providing explanations; group c: correct answer and re-viewing of video at full speed). After computer-aided training, the participants were again subjected to the video test (test 2). Participants also provided background information regarding level of training etcetera. Effects of participants' background on results were analyzed using analysis of variance, and effects of the different feedback methods were analyzed using generalized estimation equations. On test 1, 44% (group a), 48% (b), 46% (c), and 47% (high-level trainers) of horses were correctly classified. Group a participants significantly improved their test score, both with (p < 0.0001) and without (p = 0.0086) inclusion of repeated videos. For group c, significant improvement was only seen with inclusion of repeated videos (p = 0.041). For group b, no significant improvement was seen (p = 0.51). Although test 2 scores were low, computer-aided training may be useful for improving hindlimb lameness detection.

Genetic variation in hydrogen cyanide potential of perennial sorghum evaluated by colorimetry

Both annual and perennial sorghum biomass serve as important forage for ruminant animals around the world. Unfortunately, sorghum can produce hydrogen cyanide (HCN), which, if occurring in high enough concentrations, can be toxic or lethal to animals that consume it. The objectives of this study were to develop a fast and inexpensive colorimetric assay to measure the hydrogen cyanide potential (HCN-P) as well as to compare this with existing visual assays while assessing the range of variation for HCN-P among perennial and annual sorghum biomass. The HCN-P of 100 sorghum lines derived from an interspecific hybridization program was determined over 2 years (establishment and regrowth) using both visual and colorimetric assays. Visual assessment underestimated the HCN-P and was less accurate than colorimetry. Repeatability for HCN-P across all sampling dates was functionally zero in the visual assessment and low for the colorimetric assay. This was mostly explained by the significant pedigree × year interaction effects and growth stage. Growth stage substantially influenced HCN-P, which should be considered when feeding animals on fresh forage.

Optimizing Parametric Factors in CIELAB and CIEDE2000 Color-Difference Formulas for 3D-Printed Spherical Objects

The current color-difference formulas were developed based on 2D samples and there is no standard guidance for the color-difference evaluation of 3D objects. The aim of this study was to test and optimize the CIELAB and CIEDE2000 color-difference formulas by using 42 pairs of 3D-printed spherical samples in Experiment I and 40 sample pairs in Experiment II. Fifteen human observers with normal color vision were invited to attend the visual experiments under simulated D65 illumination and assess the color differences of the 82 pairs of 3D spherical samples using the gray-scale method. The performances of the CIELAB and CIEDE2000 formulas were quantified by the STRESS index and F-test with respect to the collected visual results and three different optimization methods were performed on the original color-difference formulas by using the data from the 42 sample pairs in Experiment I. It was found that the optimum parametric factors for CIELAB were kL = 1.4 and kC = 1.9, whereas for CIEDE2000, kL = 1.5. The visual data of the 40 sample pairs in Experiment II were used to test the performance of the optimized formulas and the STRESS values obtained for CIELAB/CIEDE2000 were 32.8/32.9 for the original formulas and 25.3/25.4 for the optimized formulas. The F-test results indicated that a significant improvement was achieved using the proposed optimization of the parametric factors applied to both color-difference formulas for 3D-printed spherical samples.

Protocol for a Case Control Study to Evaluate Oral Health as a Biomarker of Child Exposure to Adverse Psychosocial Experiences

Background: The early identification of children who have experienced adversity is critical for the timely delivery of interventions to improve coping and reduce negative consequences. Self-report is the usual practice for identifying children with exposure to adversity. However, physiological characteristics that signal the presence of disease or other exposures may provide a more objective identification strategy. This protocol describes a case–control study that assesses whether exposure to adversity is more common in children with tooth enamel anomalies compared to children without such anomalies. Methods: For 150 mother–child pairs from a pediatric dental clinic in Toronto, Canada, maternal interviews will assess the child’s adverse and resilience-building experiences. Per child, one (exfoliated or extracted) tooth will be assessed for suspected enamel anomalies. If anomalies are present, the child is a case, and if absent, the child is a control. Tooth assessment modalities will include usual practice for dental exams (visual assessment) and modalities with greater sensitivity to identify anomalies. Conclusion: If structural changes in children’s teeth are associated with exposure to adversity, routine dental exams could provide an opportunity to screen children for experiences of adversity. Affected children could be referred for follow-up.

Clinical Effectiveness of Immune Checkpoint Inhibitors in Non-Small-Cell Lung Cancer with a Poor Performance Status

Immune checkpoint inhibitors (ICIs) are standard treatments for patients with lung cancer. PD-1/PD-L1 or CTLA4 antibodies are chosen as the first-line therapy, contributing to the long-term survival and tolerability. Unlike molecular targeting agents, such as gefitinib, lung cancer patients with a poor performance status (PS) display unsatisfactory clinical improvements after ICI treatment. Several previous reports also demonstrated that the PS is identified as one of the most probable prognostic factors for predicting poor outcomes after ICI treatment. However, first-line pembrolizumab seemed to be effective for lung cancer patients with a PS of 2 if PD-L1 expression was greater than 50%. Currently, the induction of ICIs in patients with lung cancer with a poor PS is controversial. These problems are discussed in this review.

Midbrain area and the hummingbird sign from brain MRI in progressive supranuclear palsy and idiopathic normal pressure hydrocephalus

BACKGROUND AND PURPOSE

The main radiological finding in progressive supranuclear palsy (PSP) is reduced midbrain volume. Both qualitative (e.g., hummingbird sign) and quantitative (e.g., area measurements) markers have been noted. Recent studies have shown a similar reduction also in idiopathic normal pressure hydrocephalus (iNPH). The purpose was to investigate the reliability and accuracy of these markers in discriminating PSP from iNPH and controls.

METHODS

Eight neuroradiologists viewed sagittal MR images of the midbrain from 104 subjects: 26 PSP patients, 40 iNPH patients, and 38 healthy controls. They visually assessed whether the hummingbird sign was present or not, grading their confidence from 1 to 5. Assessments were translated into a score between +5 and -5: from maximum confidence of presence to maximum confidence of absence. A positive median score was considered to indicate hummingbird sign. Sagittal midbrain area was manually measured in each subject.

RESULTS

Seventy-seven percent of PSP patients, 65% of iNPH, and 3% of controls were visually assessed as having the hummingbird sign. Manually measured midbrain area also showed overlap between PSP and iNPH. Regarding discrimination of PSP patients, midbrain area measurements, using a cutoff of 90 mm² , yielded a higher area under the curve (AUC = 0.86) than visual assessment scores (AUC = 0.83), and higher reliability.

CONCLUSIONS

Measuring sagittal midbrain area is more accurate and reliable than visual assessment. Due to significant overlap in appearance, a midbrain with a hummingbird sign or reduced sagittal area should raise the suspicion of PSP only after other signs of iNPH have been considered.

A review of the literature on the accuracy, strengths, and limitations of visual, thoracic impedance, and electrocardiographic methods used to measure respiratory rate in hospitalized patients

Background

Respiratory rate (RR) is one of the most important indicators of a patient's health. In critically ill patients, unrecognized changes in RR are associated with poorer outcomes. Visual assessment (VA), impedance pneumography (IP), and electrocardiographic‐derived respiration (EDR) are the three most commonly used methods to assess RR. While VA and IP are widely used in hospitals, the EDR method has not been validated for use in hospitalized patients. Additionally, little is known about their accuracy compared with one another. The purpose of this systematic review was to compare the accuracy, strengths, and limitations of VA of RR to two methods that use physiologic data, namely IP and EDR.

Methods

A systematic review of the literature was undertaken using prespecified inclusion and exclusion criteria. Each of the studies was evaluated using standardized criteria.

Results

Full manuscripts for 23 studies were reviewed, and four studies were included in this review. Three studies compared VA to IP and one study compared VA to EDR. In terms of accuracy, when Bland–Altman analyses were performed, the upper and lower levels of agreement were extremely poor for both the VA and IP and VA and EDR comparisons.

Conclusion

Given the paucity of research and the fact that no studies have compared all three methods, no definitive conclusions can be drawn about the accuracy of these three methods. The clinical importance of accurate assessment of RR warrants new research with rigorous designs to determine the accuracy, and clinically meaningful levels of agreement of these methods.

Investigation of hue effects in tooth whiteness perception

OBJECTIVE

To identify the hue angles that provide the optimal perception of tooth whitening.

METHODS

Thirty-three male/female adult observers with normal color vision were recruited to assess teeth images on a color calibrated display. Images of teeth were generated which simulated color changes in each of eight hue directions in the CIE a*b* plane, each equi-distant from a baseline tooth color. Using a paired comparison study design, observers were asked to indicate which of two images had whiter teeth. The data were converted into an interval scale using Thurstone's Law of Comparative Judgment. The relationship between the hue angles and the scores was modeled by curve fitting.

RESULTS

The optimal hues were found in a region between green and blue in the CIE a*b chart. When the tooth color travels in an optimal hue direction, the same amount of color change will result in a greater change in whiteness perception than when traveling in other hue directions.

CONCLUSIONS

The optimal hues for tooth whitening were identified from the visual perception study. The most effective tooth whitening direction is to change tooth color towards the greenish-blue hue direction.

CLINICAL SIGNIFICANCE

This study gives clinicians and researchers a better understanding of tooth color hue effects in tooth whiteness perception.

Visual versus fully automated assessment of left ventricular ejection fraction

Introduction

The aim of this study is to compare three different echocardiographic methods commonly used in the assessment of left ventricle (LV) ejection fraction (EF).

Methods

All patients underwent full echocardiography including LVEF assessed using M-mode, automated EF (Auto-EF), and visual estimation by two readers.

Results

We enrolled 268 patients. Auto-EF measurement was feasible in 240 (89.5%) patients. The averaged LVEF was (52% ± 12) with the visual assessment, (51% ± 11) with Auto-EF and (57% ± 13) with M-mode. Using Bland-Altman analysis, we found that the difference between the mean visual and the Auto-EF was not significant (-0.3% [-0.5803-0.0053], P = 0.054). However, the mean EF was significantly different when comparing visual versus M-mode and Auto-EF versus M-mode with the mean differences: (-2.4365 [-2.9946--1.8783], P < 0.0001) and (-2.1490 [-2.7348--1.5631], P < 0.0001) respectively. Inter-observer variability analysis of the visual EF assessment between the two readers showed that intraclass correlation coefficient was 0.953, (95% confidence interval: 0.939-0.965, P < 0.0001), with excellent correlation between the two readers: R = 0.911, P < 0.0001).

Conclusion

The two-dimensional echocardiographic methods using Biplane Auto-EF or visual assessment were significantly comparable, whereas M-mode results in an overestimation of the LVEF.

Photograph Based Evaluation of Consumer Expectation on Healthiness, Fullness, and Acceptance of Sandwiches as Convenience Food

Sandwiches are the most common “casual-food” consumed by all age groups in Spain. Due to the importance of visual appearance to promote unplanned or impulse buying, foodservice and hospitality companies focus on improving the visual impression of their food menus to create an expectation that satisfies both sensory and hedonic consumer experiences. To provide a list of attributes about the visual appearance of sandwiches, 25 students were recruited from a university and were invited to participate in two nominal group technique (NGT) sessions. To understand whether a sandwiches’ appearance can influence the expectation of consumers, 259 participants completed an online survey specially designed from the results of the NGT sessions. Data were analyzed using conjoint, internal preference mapping and cluster analysis; the interaction effect by gender was also studied. The conjoint results indicate that visual perception about the filling (vegetal or pork based) plays the most key role overall in consumer expectation. When consumers choose vegetables as the filling, the consumers’ perceived sandwiches as healthier, but the pork filling was perceived as more attractive and satiating. Interaction effect by gender was observed in filling when females perceived pork filling as less healthy than vegetable. By acceptance, consumers were segmented into three groups. The first cluster (n = 80) selected the pork filling. The smaller group (cluster 3, n = 36) prioritized the vegetal filling, and the most numerous cluster 2 (n = 140) liked sandwiches with multigrain bread. These results may help companies to build tailor-made marketing strategies to satisfy consumer segments.

FDG-PET/CT for Response Monitoring in Metastatic Breast Cancer: The Feasibility and Benefits of Applying PERCIST

Background: We aimed to examine the feasibility and potential benefit of applying PET Response Criteria in Solid Tumors (PERCIST) for response monitoring in metastatic breast cancer (MBC). Further, we introduced the nadir scan as a reference. Methods: Response monitoring FDG-PET/CT scans in 37 women with MBC were retrospectively screened for PERCIST standardization and measurability criteria. One-lesion PERCIST based on changes in SULpeak measurements of the hottest metastatic lesion was used for response categorization. The baseline (PERCIST_baseline) and the nadir scan (PERCIST_nadir) were used as references for PERCIST analyses. Results: Metastatic lesions were measurable according to PERCIST in 35 of 37 (94.7%) patients. PERCIST was applied in 150 follow-up scans, with progression more frequently reported by PERCIST_nadir (36%) than PERCIST_baseline (29.3%; p = 0.020). Reasons for progression were (a) more than 30% increase in SUL_peak of the hottest lesion (n = 7, 15.9%), (b) detection of new metastatic lesions (n = 28, 63.6%), or both (a) and (b) (n = 9, 20.5%). Conclusions: PERCIST, with the introduction of PERCIST_nadir, allows a graphical interpretation of disease fluctuation that may be beneficial in clinical decision-making regarding potential earlier termination of non-effective toxic treatment. PERCIST seems feasible for response monitoring in MBC but prospective studies are needed to come this closer.

Local Tree Diversity Suppresses Foliar Fungal Infestation and Decreases Morphological But Not Molecular Richness in a Young Subtropical Forest

Leaf fungal pathogens alter their host species' performance and, thus, changes in fungal species composition can translate into effects at the tree community scale. Conversely, the functional diversity of tree species in a host tree's local neighbourhood can affect the host's foliar fungal infestation. Therefore, understanding the factors that affect fungal infestations is important to advance our understanding of biodiversity-ecosystem functioning (BEF) relationships. Here we make use of the largest BEF tree experiment worldwide, the BEF-China experiment, where we selected tree host species with different neighbour species. Identifying fungal taxa by microscopy and by high-throughput DNA sequencing techniques based on the internal transcribed spacer (ITS) rDNA region, we analysed the fungal richness and infestation rates of our target trees as a function of local species richness. Based on the visual microscopic assessment, we found that a higher tree diversity reduced fungal richness and host-specific fungal infestation in the host's local neighbourhood, while molecular fungal richness was unaffected. This diversity effect was mainly explained by the decrease in host proportion. Thus, the dilution of host species in the local neighbourhood was the primary mechanism in reducing the fungal disease severity. Overall, our study suggests that diverse forests will suffer less from foliar fungal diseases compared to those with lower diversity.

Modulation of p75NTR on Mesenchymal Stem Cells Increases Their Vascular Protection in Retinal Ischemia-Reperfusion Mouse Model

Mesenchymal stem cells (MSCs) are a promising therapy to improve vascular repair, yet their role in ischemic retinopathy is not fully understood. The aim of this study is to investigate the impact of modulating the neurotrophin receptor; p75NTR on the vascular protection of MSCs in an acute model of retinal ischemia/reperfusion (I/R). Wild type (WT) and p75NTR-/- mice were subjected to I/R injury by increasing intra-ocular pressure to 120 mmHg for 45 min, followed by perfusion. Murine GFP-labeled MSCs (100,000 cells/eye) were injected intravitreally 2 days post-I/R and vascular homing was assessed 1 week later. Acellular capillaries were counted using trypsin digest 10-days post-I/R. In vitro, MSC-p75NTR was modulated either genetically using siRNA or pharmacologically using the p75NTR modulator; LM11A-31, and conditioned media were co-cultured with human retinal endothelial cells (HREs) to examine the angiogenic response. Finally, visual function in mice undergoing retinal I/R and receiving LM11A-31 was assessed by visual-clue water-maze test. I/R significantly increased the number of acellular capillaries (3.2-Fold) in WT retinas, which was partially ameliorated in p75NTR-/- retinas. GFP-MSCs were successfully incorporated and engrafted into retinal vasculature 1 week post injection and normalized the number of acellular capillaries in p75NTR-/- retinas, yet ischemic WT retinas maintained a 2-Fold increase. Silencing p75NTR on GFP-MSCs coincided with a higher number of cells homing to the ischemic WT retinal vasculature and normalized the number of acellular capillaries when compared to ischemic WT retinas receiving scrambled-GFP-MSCs. In vitro, silencing p75NTR-MSCs enhanced their secretome, as evidenced by significant increases in SDF-1, VEGF and NGF release in MSCs conditioned medium; improved paracrine angiogenic response in HREs, where HREs showed enhanced migration (1.4-Fold) and tube formation (2-Fold) compared to controls. In parallel, modulating MSCs-p75NTR using LM11A-31 resulted in a similar improvement in MSCs secretome and the enhanced paracrine angiogenic potential of HREs. Further, intervention with LM11A-31 significantly mitigated the decline in visual acuity post retinal I/R injury. In conclusion, p75NTR modulation can potentiate the therapeutic potential of MSCs to harness vascular repair in ischemic retinopathy diseases.

Psychometric Properties of the QoL-ME: A Visual and Personalized Quality of Life Assessment App for People With Severe Mental Health Problems

Background: Quality of Life (QoL) assessment in people with severe mental health problems may benefit from improved personalization and accessibility. Therefore, an innovative, digital, visual, and personalized QoL assessment app for people with severe mental health problems was recently developed: the QoL-ME. The aim of this study was to evaluate the psychometric quality of the QoL-ME by assessing its reliability, validity, and responsiveness. Methods: To examine the reliability of the QoL-ME, the internal consistency of its subscales was assessed using Cronbach's Alpha. Correlations between the QoL-ME and the MANSA were computed to appraise the construct validity of the QoL-ME. Internal responsiveness was evaluated using the standardized response mean and external responsiveness was investigated using hierarchical regression. Results: Cronbach's Alpha's of the subscales of the QoL-ME ranged between 0.5 and 0.84. In accordance with expectations, the language-based core version of the QoL-ME correlated strongly (r = between 0.55 and 0.76) with the MANSA, whilst the picture-based additional modules of the QoL-ME correlated moderately (r = 0.3) with the MANSA. The standardized response mean was 0.23 and the regression model revealed a coefficient β of -0.01. Conclusions: The QoL-ME has adequate psychometric properties. In comparison with similar pictorial instruments, both the QoL-ME's reliability and validity can be considered as sufficient. The results indicate that the responsiveness of the QoL-ME is insufficient. Additional research is needed to evaluate and potentially modify the instrument to improve its responsiveness.

Visual and Personalized Quality of Life Assessment App for People With Severe Mental Health Problems: Qualitative Evaluation

BACKGROUND

QoL-ME is a digital visual personalized quality of life assessment app for people with severe mental health problems. Research reveals that e-mental health apps frequently suffer from low engagement and fall short of expectations regarding their impact on patients' daily lives. Studies often indicate that e-mental health apps ought to respect the needs and preferences of end users to achieve optimal user engagement.

OBJECTIVE

The aim of this study was to explore the experiences of users regarding the usability and functionality of QoL-ME and whether the app is actionable and beneficial for patients.

METHODS

End users (n=8) of QoL-ME contributed to semistructured interviews. An interview guide was used to direct the interviews. All interviews were audiorecorded and transcribed verbatim. Transcriptions were analyzed and coded thematically.

RESULTS

Analysis revealed 3 main themes: (1) benefit, (2) actionability, and (3) characteristics of the QoL-ME. The first theme reveals that the QoL-ME app was beneficial for the majority of respondents, primarily by prompting them to reflect on their quality of life. The current version is not yet actionable; the actionability of the QoL-ME app may be improved by enabling users to view their scores over time and by supplying practical advice for quality of life improvements. Overall, participants had positive experiences with the usability, design, and content of the app.

CONCLUSIONS

The QoL-ME app can be beneficial to users as it provides them with insight into their quality of life and elicits reflection. Incorporating more functionalities that facilitate self-management, such as advice and strategies for improving areas that are lacking, will likely make the app actionable. Patients positively regarded the usability, design, and contents of the QoL-ME app.

Evaluation of a visual interpretation method for tau-PET with 18F-flortaucipir

INTRODUCTION

Positron emission tomography targeting tau (tau-PET) is a promising diagnostic tool for the identification of Alzheimer's disease (AD). Currently available data rely on quantitative measures, and a visual interpretation method, critical for clinical translation, is needed.

METHODS

We developed a visual interpretation method for 18F-flortaucipir tau-PET and tested it on 274 individuals (cognitively normal controls, patients with mild cognitive impairment [MCI], AD dementia, and non-AD diagnoses). Two readers interpreted 18F-flortaucipir PET using two complementary indices: a global visual score and a visual distribution pattern.

RESULTS

Global visual scores were reliable, correlated with global cortical 18F-flortaucipir standardized uptake value ratio (SUVR) and were associated with clinical diagnosis and amyloid status. The AD-like 18F-flortaucipir pattern had good sensitivity and specificity to identify amyloid-positive patients with AD dementia or MCI.

DISCUSSION

This 18F-flortaucipir visual rating scheme is associated with SUVR quantification, clinical diagnosis, and amyloid status, and constitutes a promising approach to tau measurement in clinical settings.

Validity of maternal visual assessment of neonatal jaundice: a hospital-based study in Thailand

BACKGROUND

Hyperbilirubinaemia is a common cause of hospital admission of newborn infants; however, maternal visual assessment of jaundice may reduce unnecessary hospital visits.

AIMS

To investigate the validity of maternal visual assessment of neonatal jaundice to identify infants with hyperbilirubinaemia requiring phototherapy or who have significant hyperbilirubinaemia ≥239.4 µmol/L (14 mg/dL).

METHODS

A prospective study of the diagnostic accuracy of maternal visual assessment of jaundice was conducted at a university hospital in Bangkok. Mothers were trained to assess for neonatal jaundice using their infant's palms as a skin colour reference. Trained mothers who were blinded to transcutaneous bilirubin or serum bilirubin values assessed their infants and reported 'jaundice' or 'no jaundice', and determined jaundice severity using dermal icterus zones. Sensitivity and negative predictive values were used to assess the validity of visual assessment for neonatal jaundice.

RESULTS

In 180 mothers, the median (min/max) transcutaneous or serum bilirubin value in their infants was 177.8 µmol/L (119.7-309.5). The sensitivity and negative predictive values (95% CI) of maternal assessment for detecting hyperbilirubinaemia requiring phototherapy were 91.7% (73.0-99.0) and 96.6% (87.9-99.1), respectively, and for identifying significant hyperbilirubinaemia were 92.9% (76.5-99.1) and 96.6% (87.9-99.1), respectively. The accuracy of maternal report of dermal zones for serum bilirubin levels was only 44.5%. In 56 infants who received a second jaundice assessment, the sensitivity of maternal assessment for detecting increased transcutaneous or serum bilirubin was 93.9% (83.1-98.7).

CONCLUSION

Teaching mothers to visually assess their infants for neonatal jaundice was demonstrated to be feasible.

ABBREVIATIONS

CI, confidence interval; MB, microbilirubin; min/max, minimum/maximum; NPV, negative predictive value; OPD, outpatient department; PPV, positive predictive value; SD, standard deviation; TcB, transcutaneous bilirubin.

Evaluation of automated volumetric breast density software in comparison with visual assessments in an Asian population: A retrospective observational study

This study aims to compare Quantra, as an automated volumetric breast density (Vbd) tool, with visual assessment according to ACR BI-RADS density categories and to determine its potential usage in clinical practice.Five hundred randomly selected screening and diagnostic mammograms were included in this retrospective study. Three radiologists independently assigned qualitative ACR BI-RADS density categories to the mammograms. Quantra automatically calculates the volumetric density data into the system. The readers were blinded to the Quantra and other readers assessment. Inter-reader agreement and agreement between Quantra and each reader were tested. Region under the curve (ROC) analysis was performed to obtain the cut-off value to separate dense from a non-dense breast. Results with P value <.05 was taken as significant.There were 40.4% Chinese, 27% Malays, 19% Indian and 3.6% represent other ethnicities. The mean age of the patients was 57. 15%, 45.6%, 30.4%, and 9% of patients fall under BI-RADS A, B, C and D density category respectively. Fair agreement with Kappa (κ) value: 0.49, 0.38, and 0.30 were seen for Reader 1, 2 and 3 versus Quantra. Moderate agreement with κ value: 0.63, 0.64, 0.51 was seen when the data were dichotomized (density A and B to "non-dense", C and D to "dense"). The cut-off Vbd value was 13.5% to stratify dense from non-dense breasts with a sensitivity of 86.2% and specificity of 83.1% (AUC 91.4%; confidence interval: 88.8, 94.1).Quantra showed moderate agreement with radiologists visual assessment. Hence, this study adds to the available evidence to support the potential use of Quantra as an adjunct tool for breast density assessment in routine clinical practice in the Asian population. We found 13.5% is the best cut-off value to stratify dense to non-dense breasts in our study population. Its application will provide an objective, consistent and reproducible results as well as aiding clinical decision-making on the need for supplementary breast ultrasound in our screening population.

Visual classification of running economy by distance running coaches

AbstractObjectives: This study assessed the ability of coaches to rank-order distance runners on running economy (RE) through visual assessment. Methods: Running economy was measured in five trained recreational distance runners at a speed of 3.57 m_·s^-1, with a minimum VO₂ difference of 2-mL.kg^-1.min^-1 between adjacent runners. Following measurement of RE, participants were filmed from the front, side, and rear while running on a treadmill. Endurance coaches from high school to international level (N = 121) viewed each video and ranked the runners on a scale from 1 (most economical) to 5 (least economical). Coaches also completed a demographic questionnaire and listed running style biomechanical observations they used in determining each ranking. A cumulative odds ordinal logistic regression with proportional odds was run to determine the effect of coaching level, years of coaching experience, years of training experience, competition level, certification status, and education level, on the ability of distance running coaching to accurately rank RE among a group of runners. Results: No coaching characteristic was a significant predictor of ranking accuracy, χ² = 3.566, p = .735. Conclusions: Visual assessment of effort, based on RE, is a difficult task, even for the trained eye and could be related to difficulty in understanding the interaction effect of various RE factors or the translation of scientific-based knowledge to the field of play. Practically, coaches should be cautious when recommending biomechanical adjustments without considering the interconnected factors related to such changes.

Using Passive Infrared Detectors to Record Group Activity and Activity in Certain Focus Areas in Fattening Pigs

Animal behavior is an important aspect in the assessment of animal welfare. Passive infrared detectors (PID), detecting thermal changes to measure activity, have already been used to record data on the behavior of groups of animals. Within this study, the suitability of these detectors for the collection of activity profiles for focused areas is further investigated. The aim was to record the activity of a group of eleven fattening pigs in a pen, as well as the activity in the five functional areas for resting, feeding, drinking, exploration, and elimination. In order to evaluate the data obtained, the behavior was video recorded for visual assessment. In addition, relevant indoor environment parameters were recorded (ammonia, air temperature, and relative humidity). For the measurement of activity by PID, strong correlations from up to r = 0.87 (p < 0.01) could be found compared to visual assessment. The results indicate that activity changes during the day and activity in defined functional areas can be recorded using PIDs. These data combined with data of climate-related sensors could serve the farmer as a monitoring tool for early detection of behavioral changes or serve as partial aspect within a Weak Point Analysis within external on-farm consulting.

Visually clean is not necessarily microbiologically safe: Learnings from WASH assessment of maternity units of Gujarat, India

Background and Aims

Water Sanitation and Hygiene (WASH) within the context of Sustainable Development Goal (SDG) is well debated; however, WASH in health care sector is still in nascent phase, especially for maternity units. Although there are studies on WASH in maternity units, least are focused towards the microbiological safety. The objective of present study is to compare the visual assessment with microbiological assessment of selected maternity units of Gujarat (India) and to document microbiological contamination and drug resistance.

Methods

A cross-sectional study was carried out in 10 selected maternity units of Sabarkantha and Gandhinagar district of Gujarat, India, during Feb-March 2018. Two steps of Tool Box Plus were used for documentation: visual and microbiological assessment. Antimicrobial Resistance (AMR) patterns amongst positive microorganisms were also documented.

Results

Although the majority of the studied maternity units were visually clean, the microbiological findings contraindicated the same. The overall visual score across all facilities was close to 50% indicating good visual cleanliness. Out of 195 samples collected, 18% (35) samples were positive for pathogenic organisms and the majority were identified from mops and labour table. 1/3^rd of organisms were resistant to > 5 antibiotics. Pathogenic organism identified includes Acitenobacter, Klebsilla, MR CONS, E coli, Psudomonas Aeruginosa and Pseudomonas species.

Conclusions

Visual assessment alone which is currently used for assessment of hygiene is not a proxy for safety. It should be validated by the microbiological method. Microbiology surveillance should be explored to get valuable insights on the effectiveness of cleaning practices of the maternity units.

I spy with my little eye … a knee about to go 'pop'? Can coaches and sports medicine professionals predict who is at greater risk of ACL rupture?

Background

The vertical drop jump (VDJ) test is widely used for clinical assessment of ACL injury risk, but it is not clear whether such assessments are valid.

Aim

To examine if sports medicine professionals and coaches are able to identify players at risk of sustaining an ACL injury by visually assessing player performance during a VDJ test.

Methods

102 video clips of elite female handball and football players performing a baseline VDJ test were randomly extracted from a 738-person prospective cohort study that tracked ACL injuries. Of the sample, 20 of 102 went on to suffer an ACL injury. These 102 videos were uploaded to an online survey. Sports medicine professionals and coaches were invited to assess athlete performance and rate each clip with a number between 1 and 10 (1 representing low risk of sustaining an ACL injury and 10 representing high risk). Receiver operating characteristic analyses were used to assess classification accuracy and between-group differences were analysed using one-way analysis of variance.

Results

237 assessors completed the survey. Area under the curve values ranged from 0.36 to 0.60, with a mean score of 0.47, which is similar to random guessing. There were no significant differences in classification accuracy between groups (physicians, coaches, certified athletic trainers, researchers or physical therapists).

Conclusion

Assessors have poor predictive ability (no better than chance), indicating that visual assessment of a VDJ test is a poor test for assessing ACL injury risk in elite female handball and football players.

The comparability of the visual and verbal versions of the Inclusion of Community in Self scale

AIMS

Many factors affect the utility and practicality of measures in longitudinal studies characterized by transient participants such as those caught in the cycle of incarceration. The current study evaluated the psychometric equivalency of a visual and a verbal version of a single-item connectedness measure; the aim was to determine whether the different formats can be used interchangeably depending on feasibility.

METHODS

Participants were 133 jail inmates (49% male; 43% Black; M_age  = 35 years, SD = 10 years) interviewed just before release from jail.

RESULTS

Results provide evidence for the concurrent, convergent, and discriminant validity of the two ICS versions. Attempts to calibrate the verbal measure to the visual measure were moderately successful.

CONCLUSION

Taken together, results suggest the two formats are comparable, but not interchangeable; they map on to other variables in similar ways but cannot be used in lieu of one another.

Learning curve-cumulative summation analysis of visual estimation of left ventricular function in novice practitioners: A STROBE-compliant article

The aim of the present study was to determine the value of cumulative summation (CUSUM) analysis in assessing the proficiency of novice practitioners in estimating the left ventricular ejection fraction (EF).Seven novice practitioners with no echocardiography experience were recruited in this observational study. Each practitioner assessed EF from echocardiographic video files of 100 cases, one by one, and received feedback and teaching. We obtained a CUSUM score through comparison of the gold standard values of EF and the EF values determined by the practitioners. Then, the practitioners underwent the same test 4 weeks later, except without feedback and teaching, using echocardiographic video files from 100 other cases.The mean number of visual estimation cases required to pass the learning curve (LC)-CUSUM test was 56.3 ± 9.1 (95% CI 47.8-64.7). The LC-CUSUM average of the 7 novice practitioners showed improvement in visual estimation skill, with an average acceptable level achieved after a mean experience of 55 cases. In the test performed after 4 weeks, 5 of the 7 novice practitioners showed significantly good overall agreement. All novice practitioners had a kappa coefficient greater than .8, and significant and almost perfect agreement was observed. All the participants exhibited a percentage of correct answers greater than 81%.We found that the novice practitioners could acquire an acceptable level of skill for estimating EF with short-term, self-learning-focused echocardiographic training.

Undermining a common language: smartphone applications for eye emergencies

Background

Emergency room physicians are frequently called upon to assess eye injuries and vision problems in the absence of specialized ophthalmologic equipment. Technological applications that can be used on mobile devices are only now becoming available.

Objective

To review the literature on the evidence of clinical effectiveness of smartphone applications for visual acuity assessment marketed by two providers (Google Play and iTunes).

Methods

The websites of two mobile technology vendors (iTunes and Google Play) in Canada and Ireland were searched on three separate occasions using the terms “eye”, “ocular”, “ophthalmology”, “optometry”, “vision”, and “visual assessment” to determine what applications were currently available. Four medical databases (Cochrane, Embase, PubMed, Medline) were subsequently searched with the same terms AND mobile OR smart phone for papers in English published in years 2010–2017.

Results

A total of 5,024 Canadian and 2,571 Irish applications were initially identified. After screening, 44 were retained. Twelve relevant articles were identified from the health literature. After screening, only one validation study referred to one of our identified applications, and this one only partially validated the application as being useful for clinical purposes.

Conclusion

Mobile device applications in their current state are not suitable for emergency room ophthalmologic assessment, because systematic validation is lacking.

Usefulness Differs Between the Visual Assessment and Specific Binding Ratio of 123I-Ioflupane SPECT in Assessing Clinical Symptoms of Drug-Naïve Parkinson's Disease Patients

Background: In clinical practice, assessment of the striatal accumulation in ¹²³I-ioflupane single photon emission computed tomography (SPECT) is commonly performed calculating the specific binding ratio (SBR) for the whole striatum. On the other hand, visual assessment of striatal accumulation in the SPECT was recently established. However, correlations of visual assessment with motor and cognitive functions in Parkinson’s disease (PD) have rarely been examined. Differences in the usefulness of these assessments at clinics are uncertain.

Objective: We performed this study to compare correlations of cognitive and motor functions in drug-naive PD between the SBR and visual assessment using ¹²³I-ioflupane SPECT.

Methods: Cognitive and motor assessments and ¹²³I-ioflupane SPECT were performed in 47 drug-naïve PD patients with Mini-mental State Examination scores of ≥25. Cognitive function was assessed using the total score and 6 subscores of the Montreal Cognitive Assessment (MoCA) and 10 separate subtests of the Neurobehavioral Cognitive Status Examination (COGNISTAT). Motor function was assessed using the Hoehn and Yahr scale and Unified Parkinson’s Disease Rating Scale. Accumulation of ¹²³I-ioflupane was determined by visual assessment based on five grades: 1, burst striatum; 2, egg-shaped; 3, mixed type; 4, eagle wing; 5, normal striatum; and by calculating SBR averaged for the bilateral striatum using the DaTView computer software commonly used in clinical practice. Each SPECT assessment was compared with each subscore for cognitive and motor assessments.

Results: Spearman correlation analysis showed SBR was significantly correlated with the MoCA subscores of visuospatial function and attention, and with COGNISTAT subtests of attention. Visual assessment showed significant negative correlation with the Hoehn and Yahr scale. Mean score of postural instability in patients with visual grade of 1 was significantly higher than those in patients with visual grades of 2 and 3.

Conclusion: Clinical symptoms reflected by ¹²³I-ioflupane SPECT differ between the SBR and visual assessment. SBR reflects some cognitive functions, whereas a visual assessment grade of 1, which signifies decreased uptake of ¹²³I-Ioflupane in the caudate nucleus, reflects postural instability. Thus, the caudate nucleus may play an important role in posture maintenance. Our results suggest that performing both assessments is of value.

Assessing Amyloid Pathology in Cognitively Normal Subjects Using 18F-Flutemetamol PET: Comparing Visual Reads and Quantitative Methods

Our objective was to determine the optimal approach for assessing amyloid disease in a cognitively normal elderly population. Methods: Dynamic ¹⁸F-flutemetamol PET scans were acquired using a coffee-break protocol (a 0- to 30-min scan and a 90- to 110-min scan) on 190 cognitively normal elderly individuals (mean age, 70.4 y; 60% female). Parametric images were generated from SUV ratio (SUVr) and nondisplaceable binding potential (BP_ND) methods, with cerebellar gray matter as a reference region, and were visually assessed by 3 trained readers. Interreader agreement was calculated using κ-statistics, and semiquantitative values were obtained. Global cutoffs were calculated for both SUVr and BP_ND using a receiver-operating-characteristic analysis and the Youden index. Visual assessment was related to semiquantitative classifications. Results: Interreader agreement in visual assessment was moderate for SUVr (κ = 0.57) and good for BP_ND images (κ = 0.77). There was discordance between readers for 35 cases (18%) using SUVr and for 15 cases (8%) using BP_ND, with 9 overlapping cases. For the total cohort, the mean (±SD) SUVr and BP_ND were 1.33 (±0.21) and 0.16 (±0.12), respectively. Most of the 35 cases (91%) for which SUVr image assessment was discordant between readers were classified as negative based on semiquantitative measurements. Conclusion: The use of parametric BP_ND images for visual assessment of ¹⁸F-flutemetamol in a population with low amyloid burden improves interreader agreement. Implementing semiquantification in addition to visual assessment of SUVr images can reduce false-positive classification in this population.

Sensitivity, Specificity, and Accuracy of Kramer Examination of Neonatal Jaundice: Comparison with Total Bilirubin Serum

Neonatal jaundice often occurs in the first week after birth. Early detection of neonatal jaundice can prevent kernicterus as a complication of high levels of bilirubin in neonates. Visual assessment is one of the examinations introduced by Kramer to assess the presence of neonatal jaundice. The purpose of this study was to determine the sensitivity, specificity, and accuracy of Kramer's visual assessment in the examination of neonatal jaundice. This study used cross-sectional design to examine 102 infants, with the sample selected by the convenience sampling method. A 2 × 2 table diagnostic test was employed in this study to analyze the data. The results of this study showed that visual assessment of neonatal jaundice obtained a sensitivity value of 76.92%, a specificity value of 89.47%, and an accuracy value of 86.27%. This research can contribute to the development of other non-invasive methods for assessing neonatal jaundice, and thereby contribute to a decrease in neonatal morbidity.

Quantitative Identification of Nonmuscle-Invasive and Muscle-Invasive Bladder Carcinomas: A Multiparametric MRI Radiomics Analysis

BACKGROUND

Preoperative discrimination between nonmuscle-invasive bladder carcinomas (NMIBC) and the muscle-invasive ones (MIBC) is very crucial in the management of patients with bladder cancer (BC).

PURPOSE

To evaluate the discriminative performance of multiparametric MRI radiomics features for precise differentiation of NMIBC from MIBC, preoperatively.

STUDY TYPE

Retrospective, radiomics.

POPULATION

Fifty-four patients with postoperative pathologically proven BC lesions (24 in NMIBC and 30 in MIBC groups) were included.

FIELD STRENGTH/SEQUENCE

3.0T MRI/T₂ -weighted (T₂ W) and multi-b-value diffusion-weighted (DW) sequences.

ASSESSMENT

A total of 1104 radiomics features were extracted from carcinomatous regions of interest on T₂ W and DW images, and the apparent diffusion coefficient maps. Support vector machine with recursive feature elimination (SVM-RFE) and synthetic minority oversampling technique (SMOTE) were used to construct an optimal discriminative model, and its performance was evaluated and compared with that of using visual diagnoses by experts.

STATISTICAL TESTS

Chi-square test and Student's t-test were applied on clinical characteristics to analyze the significant differences between patient groups.

RESULTS

Of the 1104 features, an optimal subset involving 19 features was selected from T₂ W and DW sequences, which outperformed the other two subsets selected from T₂ W or DW sequence in muscle invasion discrimination. The best performance for the differentiation task was achieved by the SVM-RFE+SMOTE classifier, with averaged sensitivity, specificity, accuracy, and area under the curve of receiver operating characteristic of 92.60%, 100%, 96.30%, and 0.9857, respectively, which outperformed the diagnostic accuracy by experts.

DATA CONCLUSION

The proposed radiomics approach has potential for the accurate differentiation of muscle invasion in BC, preoperatively. The optimal feature subset selected from multiparametric MR images demonstrated better performance in identifying muscle invasiveness when compared with that from T₂ W sequence or DW sequence only.

LEVEL OF EVIDENCE

3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:1489-1498.

[The Effect of Metal Artifact Reduction at Different Rotation Time in Computed Tomography]

PURPOSE

The purpose of the study was to examine the metal artifact-reducing effects of single energy metal artifact reduction (SEMAR) at different rotation time.

METHODS

Helical and volume scans were employed to photograph a self-made phantom at various rotation time. Metal artifacts were examined using artifact index (AI) values and visual scores.

RESULTS

At rotation times of 0.35, 0.4, 0.5, 0.6, 0.75, and 1.0 s/rotation on the helical scans (SEMAR-ON), AI values were 66.6, 64.3, 39.7, 39.7, 40.8, and 15.4, respectively, and visual scores were 3.2, 3.4, 3.0, 3.1, 3.0, and 2.8, respectively. Similar results were obtained on the volume scans. Specifically, the AI values reduced with a decreasing rotation time, although the visual scores did not significantly differ with a rotation time changes.

CONCLUSION

The metal artifact-reducing effects of SEMAR are not altered by the rotation time.

Investigating Surface and Near-Surface Bushfire Fuel Attributes: A Comparison between Visual Assessments and Image-Based Point Clouds

Visual assessment, following guides such as the Overall Fuel Hazard Assessment Guide (OFHAG), is a common approach for assessing the structure and hazard of varying bushfire fuel layers. Visual assessments can be vulnerable to imprecision due to subjectivity between assessors, while emerging techniques such as image-based point clouds can offer land managers potentially more repeatable descriptions of fuel structure. This study compared the variability of estimates of surface and near-surface fuel attributes generated by eight assessment teams using the OFHAG and Fuels3D, a smartphone method utilising image-based point clouds, within three assessment plots in an Australian lowland forest. Surface fuel hazard scores derived from underpinning attributes were also assessed. Overall, this study found considerable variability between teams on most visually assessed variables, resulting in inconsistent hazard scores. Variability was observed within point cloud estimates but was, however, on average two to eight times less than that seen in visual estimates, indicating greater consistency and repeatability of this method. It is proposed that while variability within the Fuels3D method may be overcome through improved methods and equipment, inconsistencies in the OFHAG are likely due to the inherent subjectivity between assessors, which may be more difficult to overcome. This study demonstrates the capability of the Fuels3D method to efficiently and consistently collect data on fuel hazard and structure, and, as such, this method shows potential for use in fire management practices where accurate and reliable data is essential.

Comparison between fractional flow reserve and visual assessment for moderate coronary artery stenosis

BACKGROUND

Fractional flow reserve (FFR) is an interventional diagnostic method, based on intracoronary pressure measurement, used for the assessment of the severity of coronary artery stenoses.

AIM

Our study aimed to compare visual measurements made by multiple observers with FFR measurement in the assessment of angiographically moderate coronary artery stenosis.

METHODS

The angiographic images of moderate coronary artery lesions of 359 patients enrolled in the study were interpreted independently by three interventional cardiologists assigned as observers (O1, O2, O3).

RESULTS

In FFR, 37.9% were haemodynamically significant, while 62.1% were insignificant. 40.3% of the lesions were considered severe by O1, 39.9% by O2, and 44.4% by O3. When we compare the FFR results to the observers' decisions about lesion severity, the serious lesion percentages of all three observers were different both from each other and from the FFR result, at a statistically significant level (respectively, p < 0.001, p < 0.001). The kappa analysis performed to check the agreement between the observers' decisions and FFR revealed significant difference between FFR results and the decisions made by all observers (p < 0.001). The kappa agreement analysis performed by matching observers' decisions in pairs revealed a good agreement between O1 and O2 and a moderate agreement between O2 and O3 as well as O1 and O3, although there was still a significant disagreement between all pairs of observers (p < 0.001).

CONCLUSIONS

Visual assessment, even when performed by experienced interventional cardiologists, does not yield similar results with FFR procedure in the process of determination of the functional importance of moderately severe coronary artery stenoses.

How to assess vision

Rationale and key points An objective assessment of the patient's vision is important to assess variation from 'normal' vision in acute and community settings, to establish a baseline before examination and treatment in the emergency department, and to assess any changes during ophthalmic outpatient appointments. » Vision is one of the essential senses that permits people to make sense of the world. » Visual assessment does not only involve measuring central visual acuity, it also involves assessing the consequences of reduced vision. » Assessment of vision in children is crucial to identify issues that might affect vision and visual development, and to optimise lifelong vision. » Untreatable loss of vision is not an inevitable consequence of ageing. » Timely and repeated assessment of vision over life can reduce the incidence of falls, prevent injury and optimise independence. Reflective activity 'How to' articles can help update you practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article might change your practice when assessing people holistically. 2. How you could use this article to educate your colleagues in the assessment of vision.

Goodness of fit tools for dose-response meta-analysis of binary outcomes

Goodness of fit evaluation should be a natural step in assessing and reporting dose-response meta-analyses from aggregated data of binary outcomes. However, little attention has been given to this topic in the epidemiological literature, and goodness of fit is rarely, if ever, assessed in practice. We briefly review the two-stage and one-stage methods used to carry out dose-response meta-analyses. We then illustrate and discuss three tools specifically aimed at testing, quantifying, and graphically evaluating the goodness of fit of dose-response meta-analyses. These tools are the deviance, the coefficient of determination, and the decorrelated residuals-versus-exposure plot. Data from two published meta-analyses are used to show how these three tools can improve the practice of quantitative synthesis of aggregated dose-response data. In fact, evaluating the degree of agreement between model predictions and empirical data can help the identification of dose-response patterns, the investigation of sources of heterogeneity, and the assessment of whether the pooled dose-response relation adequately summarizes the published results. © 2015 The Authors. Research Synthesis Methods published by John Wiley & Sons, Ltd.

Perceptual influence of elementary three-dimensional geometry: (2) fundamental object parts

Objects usually consist of parts and the question arises whether there are perceptual features which allow breaking down an object into its fundamental parts without any additional (e.g., functional) information. As in the first paper of this sequence, we focus on the division of our world along convex to concave surface transitions. Here we are using machine vision to produce convex segments from 3D-scenes. We assume that a fundamental part is one, which we can easily name while at the same time there is no natural subdivision possible into smaller parts. Hence in this experiment we presented the computer vision generated segments to our participants and asked whether they can identify and name them. Additionally we control against segmentation reliability and we find a clear trend that reliable convex segments have a high degree of name-ability. In addition, we observed that using other image-segmentation methods will not yield nameable entities. This indicates that convex-concave surface transition may indeed form the basis for dividing objects into meaningful entities. It appears that other or further subdivisions do not carry such a strong semantical link to our everyday language as there are no names for them.

Comparative clinical evaluation of the efficacy of a new method for caries diagnosis and excavation

Aim:

The purpose of this study is to compare the efficiency of fluorescence-aided caries excavation (FACE) to remove carious dentin primary teeth with that of conventional methods.

Methods and Materials:

After caries excavation was carried out, dentin surfaces were conventionally inspected using visual tactile criteria and 415 cavities which were classified as caries-free, re-inspected with Face-Light and caries detector dye (CDD) methods. Orange-red fluorescing areas classified as carious dentin, as well as stained carious dentin. All the data were recorded according to localization of the caries and determination efficiency of the methods. X² test was used to compare the mean values of both Face-Light and dye applications, while Wilcoxon test performed to evaluate the effectiveness for each diagnostic method.

Results:

A total of 273 patients with 415 Class II (OM/OD) cavities (1.65 ± 0.52 teeth per patient) with carious lesions in molar and premolar teeth, were examined. Out of 415 teeth, in 149 teeth (35.9%) no caries findings had been illustrated. While FACE detected remaining carious or partially removed areas in 237 teeth (57.2%), CDD stained only 29 teeth by itself (P < 0.05).

Conclusion:

In conclusion, FACE has a higher detectability compared to visual inspection and caries detector dye in diagnosis and removal of carious dentin.

Visual Acuity Testing Using a Random Method Visual Acuity Application

BACKGROUND

A visual acuity (VA) testing application for the iPad® (Apple, Cupertino, CA) tablet computer using the mirroring technique was developed that randomly presented letters categorized by cognoscibility. The aim of this study was to assess whether measurements of distance VA using this application were in agreement with existing standard clinical tests of VA in adults with normal vision.

MATERIALS AND METHODS

Forty-three normally sighted subjects were tested using the Early Treatment of Diabetic Retinopathy Study (ETDRS) chart. The log minutes of arc (logMAR) VA results were compared with those from the iPad-based application, which contains a Snellen chart, a Tumbling E chart, a Landolt C chart, and a VA chart consisting of Arabic figures. After a 10-min break, subjects were retested with each test in the same order. Agreement was assessed by determining the 95% limits of agreement ± 1.96 standard deviation of the differences between tests.

RESULTS

The logMAR VA showed no significant difference between the ETDRS chart and the iPad Snellen chart (p = 0.66) and iPad Arabic figure chart (p = 0.29). The logMAR VA of the ETDRS chart was significantly better than that of the iPad Tumbling E chart (p < 0.01) or iPad Landolt C chart (p < 0.01). The subjects showed chart letter memory of the ETDRS chart (p < 0.05), Tumbling E chart (p = 0.03), and Landolt C chart (p = 0.001) but not of the iPad Snellen chart (p = 0.62) and iPad Arabic figure chart (p = 0.12).

CONCLUSIONS

The iPad-based application of VA charts showed similar repeatability and may be a rapid and convenient alternative to some existing measures. The mirroring technique provides portability and accessibility for VA charts.

Comparison of simplified parametric methods for visual interpretation of 11C-Pittsburgh compound-B PET images

This study compared several parametric imaging methods to determine the optimal approach for visual assessment of parametric Pittsburgh compound-B ((11)C-PIB) PET images to detect cortical amyloid deposition in different memory clinic patient groups.

METHODS

Dynamic (11)C-PIB scanning of 120 memory clinic patients was performed. Parametric nondisplaceable binding potential (BPND) images were compared with standardized uptake value (SUV) and SUV ratio images. Images were visually assessed by 3 independent readers, and both interreader and intermethod agreement was determined.

RESULTS

Both 90-min (Fleiss κ = 0.88) and 60-min (Fleiss κ = 0.89) BPND images showed excellent interreader agreement, whereas agreement was good to moderate for SUV ratio images (Fleiss κ = 0.68) and SUV images (Fleiss κ = 0.59). Intermethod agreement varied substantially between readers, although BPND images consistently showed the best performance.

CONCLUSION

The use of BPND images provided the highest interreader and intermethod agreement and is therefore the method of choice for optimal visual interpretation of (11)C-PIB PET scans.

Assessment of a quantitative metric for 4D CT artifact evaluation by observer consensus

The benefits of four-dimensional computed tomography (4D CT) are limited by the presence of artifacts that remain difficult to quantify. A correlation-based metric previously proposed for ciné 4D CT artifact identification was further validated as an independent artifact evaluator by using a novel qualitative assessment featuring a group of observers reaching a consensus decision on artifact location and magnitude. The consensus group evaluated ten ciné 4D CT scans for artifacts over each breathing phase of coronal lung views assuming one artifact per couch location. Each artifact was assigned a magnitude score of 1-5, 1 indicating lowest severity and 5 indicating highest severity. Consensus group results served as the ground truth for assessment of the correlation metric. The ten patients were split into two cohorts; cohort 1 generated an artifact identification threshold derived from receiver operating characteristic analysis using the Youden Index, while cohort 2 generated sensitivity and specificity values from application of the artifact threshold. The Pearson correlation coefficient was calculated between the correlation metric values and the consensus group scores for both cohorts. The average sensitivity and specificity values found with application of the artifact threshold were 0.703 and 0.476, respectively. The correlation coefficients of artifact magnitudes for cohort 1 and 2 were 0.80 and 0.61, respectively, (p < 0.001 for both); these correlation coefficients included a few scans with only two of the five possible magnitude scores. Artifact incidence was associated with breathing phase (p < 0.002), with presentation less likely near maximum exhale. Overall, the correlation metric allowed accurate and automated artifact identification. The consensus group evaluation resulted in efficient qualitative scoring, reduced interobserver variation, and provided consistent identification of artifact location and magnitudes.

Automatic and objective assessment of alternating tapping performance in Parkinson's disease

This paper presents the development and evaluation of a method for enabling quantitative and automatic scoring of alternating tapping performance of patients with Parkinson's disease (PD). Ten healthy elderly subjects and 95 patients in different clinical stages of PD have utilized a touch-pad handheld computer to perform alternate tapping tests in their home environments. First, a neurologist used a web-based system to visually assess impairments in four tapping dimensions ('speed', 'accuracy', 'fatigue' and 'arrhythmia') and a global tapping severity (GTS). Second, tapping signals were processed with time series analysis and statistical methods to derive 24 quantitative parameters. Third, principal component analysis was used to reduce the dimensions of these parameters and to obtain scores for the four dimensions. Finally, a logistic regression classifier was trained using a 10-fold stratified cross-validation to map the reduced parameters to the corresponding visually assessed GTS scores. Results showed that the computed scores correlated well to visually assessed scores and were significantly different across Unified Parkinson's Disease Rating Scale scores of upper limb motor performance. In addition, they had good internal consistency, had good ability to discriminate between healthy elderly and patients in different disease stages, had good sensitivity to treatment interventions and could reflect the natural disease progression over time. In conclusion, the automatic method can be useful to objectively assess the tapping performance of PD patients and can be included in telemedicine tools for remote monitoring of tapping.