Diagnostic Accuracy of SPECT for Mild Traumatic Brain Injury: A Systematic Review and Meta-analysis.

PURPOSE: This study examines the diagnostic accuracy of brain perfusion SPECT for mild traumatic brain injury (mTBI). PATIENTS AND METHODS: A systematic review and meta-analysis was performed according to PRISMA guidelines (PROSPERO: CRD42023484636). Five databases were searched for studies evaluating brain perfusion SPECT in adult patients with mTBI (GCS 13-15). Study quality was assessed using a modified QUADAS-2 tool. A meta-analysis was performed to pool proportions of hypoperfusion abnormalities across brain lobes. RESULTS: Of 4735 records, 22 studies (5 longitudinal [40% high quality], 17 cross-sectional [24% high quality]) were included totaling 800 patients (mean age, 37.4 ± 12.6 years; 36.4% female). Meta-analysis of proportions indicated that the frontal lobe most frequently showed hypoperfusion on brain perfusion SPECT (pooled proportion 40.1% [95% confidence interval, 31.2% to 49.8%], 99/254, I2 = 54.5%), followed by the temporal lobe (26.1% [95% confidence interval, 19.9% to 33.6%], 68/254, I2 = 30.7%). Several studies found that hypoperfusion abnormalities were associated with neuropsychological findings. Also, brain perfusion SPECT could detect abnormalities not seen on MRI. Abnormalities in perfusion on brain perfusion SPECT may be more readily detected with a quantitative assessment compared with a visual assessment alone, although there appears to be no consensus on the optimal method for image interpretation. Evidence evaluating the sensitivity and specificity of brain perfusion SPECT for mTBI was limited. Using the GRADE framework, the evidence was rated as low. CONCLUSIONS: Although perfusion abnormalities can be seen in patients with mTBI, commonly in the frontal and temporal lobes, the findings are nonspecific and may derive from various factors. Ultimately, brain perfusion SPECT provides additional information for mTBI, but the final added value for the detection of mTBI is unknown.

Health optimization of older people in prison.

This article examines the leadership challenges of prison healthcare, specifically focusing on the ageing inmate population. It highlights the distinct health burdens faced by this demographic, including higher disease prevalence and an accelerated ageing process. The concept of prison activities of daily living is central to addressing these challenges, emphasizing the need to tailor health assessments and care plans to the unique prisoner-environment interactions. This article advocates for inclusive person-centred care. It suggests that involving older prisoners in their care planning, aligned with the "ageing in the right place" principle, can significantly improve their quality of life. Additionally, it explores strategies to combat social isolation and loneliness among older prisoners, such as intergenerational activities and prison-community partnerships. Health leaders can echo these findings in policy development and incorporate collaborative, inclusive, diverse, and intergenerational models that address the complex health needs of older prisoners.

Facilitators of and barriers to patient and public involvement in building learning health systems in community health services settings: a scoping review protocol.

INTRODUCTION: The development of learning health systems (LHSs) has often focused on optimally leveraging data. More attention should be paid to patient and public involvement or community engagement in forming learning communities that work together to build LHS. This scoping review aims to identify facilitators of and barriers to involving patients and the public in building LHSs in community health services settings. METHODS AND ANALYSIS: We will use the Joanna Briggs Institute's scoping review methodology. We will review literature in English published from 1 January 2007 to 31 December 2022. The databases that will be searched are MEDLINE, CINAHL, Embase, Web of Science, Scopus, AgeLine, PsycINFO and Web of Science. Key inclusion and exclusion criteria include the following: we will only consider a learning community in a community health services context (eg, home care, long-term care, primary care); we will exclude literature on acute care settings; and we will consider any research designs apart from big data analytics. We will review all sources, including university student theses and dissertations. The review will proceed in three steps: (1) we will identify keywords and index terms from the MEDLINE and CINAHL databases; (2) using the keywords and index terms identified in step (1), we will search other databases and (3) we will handsearch the reference lists of the selected literature and will search for grey literature using Google. Two research assistants will screen the titles and abstracts separately, with reference to the inclusion criteria. Two researchers will then assess the full text of selected studies, also in reference to the inclusion criteria. We will present the findings in a charting table and provide a narrative summary. ETHICS AND DISSEMINATION: This work does not require ethics approval because the data for this scoping review are publicly available. The findings will be presented in a journal article and at conferences.

Natural history of pediatric morphine leukoencephalopathy on CT and MRI.

An increased awareness of opioids and the imaging appearance in opioid overdose-related leukoencephalopathy has rapidly become crucial with respect to its identification by emergency radiologists. It is a potentially life-threatening condition and is associated with devastating neurological outcomes. Thus, early diagnosis and management are paramount. We report a rare case of toxic leukoencephalopathy in a 20-month-old male patient secondary to morphine overdose in the outpatient setting following discharge from uncomplicated urethroplasty. Although pediatric toxic leukoencephalopathy has been reported previously in the literature, our case report is unique as it involves morphine, a less commonly used opioid in the outpatient setting. Moreover, we have provided brain computed tomography and magnetic resonance imaging and highlighted findings in the acute and chronic stages of the disease trajectory. This case report highlights the importance for radiologists, especially those involved in emergency care, to have a high index of suspicion for toxic leukoencephalopathy, a potentially devastating but treatable condition.

The LaMIT database: A read speech corpus for acoustic studies of the Italian language toward lexical access based on the detection of landmarks and other acoustic cues to features.

The LaMIT database consists in recordings of 100 Italian sentences. The sentences in the database were designed so to include all phonemes of the Italian language, and also take into account the typical frequency of each phoneme in written Italian. Four native adult speakers of Standard Italian, raised and living in Rome, Italy, two female and two male, pronounced the sentences in two different recording sessions; two repetitions for each sentence per speaker were therefore collected, for a total of 800 recordings. The database was specifically created for application in the LaMIT project, that focuses on the application to the Italian language of the Lexical Access model proposed by Ken Stevens for American English. The model relies on the detection of specific acoustic discontinuities called landmarks and other acoustic cues to features that characterize each phoneme. Each recording was thus processed to generate a set of labeling files that identify both predicted landmarks and other cues, and actual landmarks/cues. The labeling files, compiled according to the labeling syntax used in the Praat speech processing software, are also made available as part of the LAMIT database.

The forgotten lacrimal gland and lacrimal drainage apparatus: pictorial review of CT and MRI findings and differential diagnosis.

The lacrimal gland is a bilobed serous gland located in the superolateral aspect of the orbit. Lacrimal system pathologies can be broadly divided into pathologies of the lacrimal gland and those of the nasolacrimal drainage apparatus. These include distinct congenital, infectious, inflammatory, and benign, indeterminate, and malignant neoplastic lesions. Trauma and resultant fractures affecting lacrimal drainage apparatus is not part of this review; only non-traumatic diseases will be discussed. CT is the initial modality of choice because of its ability to delineate lacrimal system anatomy and demonstrate most lacrimal drainage system abnormalities and their extent. It also assesses bony architecture and characterizes any osseous changes. MRI is helpful in further characterizing these lesions and better assessing involvement of the surrounding soft tissue structures. In this pictorial review, we will review the anatomy of the lacrimal system, describe CT/MRI findings of the common and uncommon lacrimal system abnormalities and discuss relevance of imaging with regards to patient management.

Lexical and syntactic gemination in Italian consonants-Does a geminate Italian consonant consist of a repeated or a strengthened consonant?

Two types of consonant gemination characterize Italian: lexical and syntactic. Italian lexical gemination is contrastive, so that two words may differ by only one geminated consonant. In contrast, syntactic gemination occurs across word boundaries and affects the initial consonant of a word in specific contexts, such as the presence of a monosyllabic morpheme before the word. This study investigates the acoustic correlates of Italian lexical and syntactic gemination, asking if the correlates for the two types are similar in the case of stop consonants. Results confirmed previous studies showing that duration is a prominent gemination cue, with a lengthened consonant closure and a shortened pre-consonant vowel for both types. Results also revealed the presence, in about 10%-12% of instances, of a double stop-release burst, providing strong support for the biphonematic nature of Italian geminated stop consonants. Moreover, the timing of these bursts suggests a different planning process for lexical vs syntactic geminates. The second burst, when present, is accommodated within the closure interval in syntactic geminates, while lexical geminates are lengthened by the extra burst. This suggests that syntactic gemination occurs during a post-lexical phase of production planning, after timing has already been established.

Predation favours Bicyclus anynana butterflies with fewer forewing eyespots.

There are fewer eyespots on the forewings versus hindwings of nymphalids but the reasons for this uneven distribution remain unclear. One possibility is that, in many butterflies, the hindwing covers part of the ventral forewing at rest and there are fewer forewing sectors to display eyespots (covered eyespots are not continuously visible and are less likely to be under positive selection). A second explanation is that having fewer forewing eyespots confers a selective advantage against predators. We analysed wing overlap at rest in 275 nymphalid species with eyespots and found that many have exposed forewing sectors without eyespots: i.e. wing overlap does not constrain the forewing from having the same number or more eyespots than the hindwing. We performed two predation experiments with mantids to compare the relative fitness of and attack damage patterns on two forms of Bicyclus anynana butterflies, both with seven hindwing eyespots, but with two (in wild-type) or four (in Spotty) ventral forewing eyespots. Spotty experienced more intense predation on the forewings, were shorter-lived and laid fewer eggs. These results suggest that predation pressure limits forewing eyespot number in B. anynana. This may occur if attacks on forewing eyespots have more detrimental consequences for flight than attacks on hindwing eyespots.

The Efficacy of Collaborative Authoring of Video Scene Descriptions.

The majority of online video contents remain inaccessible to people with visual impairments due to the lack of audio descriptions to depict the video scenes. Content creators have traditionally relied on professionals to author audio descriptions, but their service is costly and not readily-available. We investigate the feasibility of creating more cost-effective audio descriptions that are also of high quality by involving novices. Specifically, we designed, developed, and evaluated ViScene, a web-based collaborative audio description authoring tool that enables a sighted novice author and a reviewer either sighted or blind to interact and contribute to scene descriptions (SDs)-text that can be transformed into audio through text-to-speech. Through a mixed-design study with N = 60 participants, we assessed the quality of SDs created by sighted novices with feedback from both sighted and blind reviewers. Our results showed that with ViScene novices could produce content that is Descriptive, Objective, Referable, and Clear at a cost of i.e., US$2.81pvm to US$5.48pvm, which is 54% to 96% lower than the professional service. However, the descriptions lacked in other quality dimensions (e.g., learning, a measure of how well an SD conveys the video's intended message). While professional audio describers remain the gold standard, for content creators who cannot afford it, ViScene offers a cost-effective alternative, ultimately leading to a more accessible medium.

MB-FSGAN: Joint segmentation and quantification of kidney tumor on CT by the multi-branch feature sharing generative adversarial network.

The segmentation of the kidney tumor and the quantification of its tumor indices (i.e., the center point coordinates, diameter, circumference, and cross-sectional area of the tumor) are important steps in tumor therapy. These quantifies the tumor morphometrical details to monitor disease progression and accurately compare decisions regarding the kidney tumor treatment. However, manual segmentation and quantification is a challenging and time-consuming process in practice and exhibit a high degree of variability within and between operators. In this paper, MB-FSGAN (multi-branch feature sharing generative adversarial network) is proposed for simultaneous segmentation and quantification of kidney tumor on CT. MB-FSGAN consists of multi-scale feature extractor (MSFE), locator of the area of interest (LROI), and feature sharing generative adversarial network (FSGAN). MSFE makes strong semantic information on different scale feature maps, which is particularly effective in detecting small tumor targets. The LROI extracts the region of interest of the tumor, greatly reducing the time complexity of the network. FSGAN correctly segments and quantifies kidney tumors through joint learning and adversarial learning, which effectively exploited the commonalities and differences between the two related tasks. Experiments are performed on CT of 113 kidney tumor patients. For segmentation, MB-FSGAN achieves a pixel accuracy of 95.7%. For the quantification of five tumor indices, the R2 coefficient of tumor circumference is 0.9465. The results show that the network has reliable performance and shows its effectiveness and potential as a clinical tool.

Interacting Effects of Eyespot Number and Ultraviolet Reflectivity on Predation Risk in Bicyclus anynana (Lepidoptera: Nymphalidae).

Small marginal eyespots on lepidopteran wings are conspicuous elements that attract a predator's attention to deflect attacks away from the body, but the role of ultraviolet (UV) reflectivity at the center of these patterns and variation in eyespot number in altering the function of eyespots remains unclear. Here, we performed a field-based predation experiment with artificial prey items based on the appearance of squinting bush brown butterflies Bicyclus anynana (Butler, 1879). We tested how two visual properties of the wing pattern affect predation risk: i) the number of eyespots on the ventral forewing surface-two or four; and ii) the UV reflectivity of eyespot centers-normal (where the UV reflectivity of the centers contrasts strongly with that of the darker surrounding ring) or blocked (where this contrast is reduced). In total, 807 prey items were deployed at two sites. We found a significant interaction between the number of ventral forewing eyespots and UV reflectivity in the eyespot centers: in items with fewer eyespots, blocking UV resulted in increased predation risk whereas in items with more eyespots, blocking UV resulted in decreased predation risk. If higher predation of paper models can be equated with higher levels of wing margin/eyespot conspicuity, these results demonstrate that UV reflectivity is an important factor in making eyespots more conspicuous to predators and suggest that the fitness of particular butterfly eyespot number variants may depend on the presence or absence of UV in their centers and on the ability of local predator guilds to detect UV.

Multimodal imaging of aortic annulus and root geometry after valve sparing root reconstruction.

BACKGROUND: Controversy exists regarding the optimal annular stabilization technique following valve sparing aortic root reconstruction (VSRR) with no comprehensive imaging data to evaluate the natural history of aortic root graft geometry, aortic valve competency and patient prognosis post-reconstruction. METHODS: Between 2008-2017, 70 consecutive patients (mean age 56.4±16.4 years, 19.7% females) underwent VSRR. All patients were prospectively evaluated annually with clinical follow-up, echocardiography and CT imaging. Patients were assessed for survival, freedom from reoperation, degree of regurgitation, New York Heart Association (NYHA) status and graft complications and followed up to nine years post-operatively (mean 36±21 months). RESULTS: The largest increase of the aortic annulus diameter observed during the surveillance period was 2.64%±5.4% which occurred between the second and third years of follow-up and the aortic sinuses, sinotubular junction and ascending aorta all remained relatively stable based on annual CT imaging. Echocardiographic data showed far more variability in measurements at each annual post-operative visit with far less precision compared to the CT measurements taken at the same time. Due to the large variability and greater standard deviations, no significant difference was detected between the more precise CT measurements and those from the echocardiogram images. The overall survival rate was 94.3% (66 patients) at one year. Freedom from reoperation was 98.6% (69 patients). Throughout the entire duration of follow-up, aortic insufficiency was identified as 0 in 46 (65.7%), 1+ in 19 (27.1%), 2+ in 4 (5.7%), 3+ in 0 (0%) and 4+ in 1 (1.4%). Mean NYHA status was 1.1±0.3 at most recent follow-up for all patients. CT evidence showed 97.0% (64 patients) freedom from graft complication including: endocarditis, thrombosis, embolism, aneurysm, pseudoaneurysm, dehiscence, dissection and kinking. CONCLUSIONS: The annual imaging data presented here demonstrates stability of the Dacron aortic annuloplasty reconstruction over time, without the need for internal or external annular stabilization. CT imaging proved to be far more reliable than echocardiographic images, however given the stability, annual CT imaging is of little benefit. This is the first prospective study to compare echocardiographic, CT and clinical data following VSRR.

Eligibility for Minimally Invasive Coronary Artery Bypass: Examination of Epicardial Adipose Tissue Using Computed Tomography.

OBJECTIVE: A variable that necessitates conversion to a conventional full-sternotomy coronary artery bypass procedure from a robotic-assisted endoscopic single-vessel small thoracotomy is the inability to visualize the left anterior descending coronary artery within the surrounding epicardial adipose tissue using the endoscopic camera. The purpose of this study was to determine whether anatomical properties of the epicardial adipose tissue examined using preoperative computed tomography (CT) images are able to predict and thus reduce the need for intraoperative conversion based on effective preoperative exclusion criteria. METHODS: Retrospective analysis of patient preoperative CT angiography scans from both converted (n = 17) and successful robotic-assisted (n = 17) procedures was performed. Where possible, measurements of epicardial adipose tissue were acquired from axial slices, at the most accessible segment of the left anterior descending coronary artery. RESULTS: Results indicate that patients who successfully underwent the endoscopic single-vessel small thoracotomy procedure (mean ± SD depth, 4.9 ± 1.9 mm) had significantly less epicardial adipose tissue (38%, P = 0.002) overlying the vessel toward the lateral chest wall than those who were converted to the full-sternotomy approach intraoperatively (mean ± SD depth, 7.9 ± 3.2 mm). Using this as a retrospective exclusion criterion reduces the conversion rate for this group by 47%, while maintaining a high specificity (94%). No significant differences exist between the two groups with respect to the remaining epicardial adipose tissue measurements or body mass index. CONCLUSIONS: The addition of CT angiography measurements of the epicardial adipose tissue overlying the left anterior descending coronary artery may enhance preoperative surgical planning for this procedure, thereby reducing the instances of procedural changes.

Descriptor Learning via Supervised Manifold Regularization for Multioutput Regression.

Multioutput regression has recently shown great ability to solve challenging problems in both computer vision and medical image analysis. However, due to the huge image variability and ambiguity, it is fundamentally challenging to handle the highly complex input-target relationship of multioutput regression, especially with indiscriminate high-dimensional representations. In this paper, we propose a novel supervised descriptor learning (SDL) algorithm for multioutput regression, which can establish discriminative and compact feature representations to improve the multivariate estimation performance. The SDL is formulated as generalized low-rank approximations of matrices with a supervised manifold regularization. The SDL is able to simultaneously extract discriminative features closely related to multivariate targets and remove irrelevant and redundant information by transforming raw features into a new low-dimensional space aligned to targets. The achieved discriminative while compact descriptor largely reduces the variability and ambiguity for multioutput regression, which enables more accurate and efficient multivariate estimation. We conduct extensive evaluation of the proposed SDL on both synthetic data and real-world multioutput regression tasks for both computer vision and medical image analysis. Experimental results have shown that the proposed SDL can achieve high multivariate estimation accuracy on all tasks and largely outperforms the algorithms in the state of the arts. Our method establishes a novel SDL framework for multioutput regression, which can be widely used to boost the performance in different applications.

Direct and simultaneous estimation of cardiac four chamber volumes by multioutput sparse regression.

Cardiac four-chamber volume estimation serves as a fundamental and crucial role in clinical quantitative analysis of whole heart functions. It is a challenging task due to the huge complexity of the four chambers including great appearance variations, huge shape deformation and interference between chambers. Direct estimation has recently emerged as an effective and convenient tool for cardiac ventricular volume estimation. However, existing direct estimation methods were specifically developed for one single ventricle, i.e., left ventricle (LV), or bi-ventricles; they can not be directly used for four chamber volume estimation due to the great combinatorial variability and highly complex anatomical interdependency of the four chambers. In this paper, we propose a new, general framework for direct and simultaneous four chamber volume estimation. We have addressed two key issues, i.e., cardiac image representation and simultaneous four chamber volume estimation, which enables accurate and efficient four-chamber volume estimation. We generate compact and discriminative image representations by supervised descriptor learning (SDL) which can remove irrelevant information and extract discriminative features. We propose direct and simultaneous four-chamber volume estimation by the multioutput sparse latent regression (MSLR), which enables jointly modeling nonlinear input-output relationships and capturing four-chamber interdependence. The proposed method is highly generalized, independent of imaging modalities, which provides a general regression framework that can be extensively used for clinical data prediction to achieve automated diagnosis. Experiments on both MR and CT images show that our method achieves high performance with a correlation coefficient of up to 0.921 with ground truth obtained manually by human experts, which is clinically significant and enables more accurate, convenient and comprehensive assessment of cardiac functions.

Satisfaction and Quality of Life Related to Chemotherapy With an Arm Port: A Pilot Study.

PURPOSE: Placement of arm ports, or totally implanted venous access devices, is a common practice in our interventional radiology suite. We implant a miniaturized port in the upper arm for the provision of long-term chemotherapy. We hypothesized that there was general satisfaction with these arm ports and they have a minimal negative impact on quality of life. In this study we aimed to assess our hypotheses. METHODS: We surveyed subjects, who having previously received an arm port for chemotherapy to treat a malignancy, attended the interventional room for its removal. The survey assessed the port's effect on lifestyle, the degree of device-related pain, the acceptance of the port, and the willingness to have another port in the future. RESULTS: Survey responses from 77 subjects were reviewed. On a scale of 1 (most negative) to 10 (most positive), respondents indicated that the port system was a very positive enhancement to their treatment (satisfaction = 9.2 ± 2.0 and positivity = 8.8 ± 2.2). The port had little impact on daily activities. The mean score for the likelihood of choosing to have another port placed if additional treatment was required was 9.1 ± 2.1. DISCUSSION: The arm port in this study did not negatively impact subject satisfaction and quality of life for this cohort. Most subjects rated the device utility highly and felt that the port was a positive enhancement to their treatment, one that they would possibly utilise again in future, if need be.