Aortic stenosis post-COVID-19: a mathematical model on waiting lists and mortality.

OBJECTIVES: To provide estimates for how different treatment pathways for the management of severe aortic stenosis (AS) may affect National Health Service (NHS) England waiting list duration and associated mortality. DESIGN: We constructed a mathematical model of the excess waiting list and found the closed-form analytic solution to that model. From published data, we calculated estimates for how the strategies listed under Interventions may affect the time to clear the backlog of patients waiting for treatment and the associated waiting list mortality. SETTING: The NHS in England. PARTICIPANTS: Estimated patients with AS in England. INTERVENTIONS: (1) Increasing the capacity for the treatment of severe AS, (2) converting proportions of cases from surgery to transcatheter aortic valve implantation and (3) a combination of these two. RESULTS: In a capacitated system, clearing the backlog by returning to pre-COVID-19 capacity is not possible. A conversion rate of 50% would clear the backlog within 666 (533-848) days with 1419 (597-2189) deaths while waiting during this time. A 20% capacity increase would require 535 (434-666) days, with an associated mortality of 1172 (466-1859). A combination of converting 40% cases and increasing capacity by 20% would clear the backlog within a year (343 (281-410) days) with 784 (292-1324) deaths while awaiting treatment. CONCLUSION: A strategy change to the management of severe AS is required to reduce the NHS backlog and waiting list deaths during the post-COVID-19 'recovery' period. However, plausible adaptations will still incur a substantial wait to treatment and many hundreds dying while waiting.

Experience with searching in displays containing depth improves search performance by training participants to search more exhaustively.

In a typical visual search task, participants search for single targets amongst displays containing non-overlapping objects that are presented on a single depth plane. Recent work has begun to examine displays containing overlapping objects that are presented on different depth planes to one another. It has been found that searching displays containing depth improves response accuracy by making participants more likely to fixate targets and to identify targets after fixating them. Here we extended this previous research by seeking first of all to replicate the previous pattern of results, and then to determine whether extensive training using depth in search transfers to two-dimensional displays. We provided participants with sixteen sessions of training with displays containing transparent overlapping objects presented in depth, and found a similar pattern of results to our previous study. We also found evidence that some performance improvements from the depth training transferred to search of two-dimensional displays that did not contain depth. Further examinations revealed that participants learn to search more exhaustively (i.e., search for longer) in displays containing depth. We conclude that depth does influence search performance but the influences depend very much on the stimuli and the degree of overlap within them.

Adding depth to overlapping displays can improve visual search performance.

Standard models of visual search have focused upon asking participants to search for a single target in displays where the objects do not overlap one another, and where the objects are presented on a single depth plane. This stands in contrast to many everyday visual searches wherein variations in overlap and depth are the norm, rather than the exception. Here, we addressed whether presenting overlapping objects on different depths planes to one another can improve search performance. Across 4 different experiments using different stimulus types (opaque polygons, transparent polygons, opaque real-world objects, and transparent X-ray images), we found that depth was primarily beneficial when the displays were transparent, and this benefit arose in terms of an increase in response accuracy. Although the benefit to search performance only appeared in some cases, across all stimulus types, we found evidence of marked shifts in eye-movement behavior. Our results have important implications for current models and theories of visual search, which have not yet provided detailed accounts of the effects that overlap and depth have on guidance and object identification processes. Moreover, our results show that the presence of depth information could aid real-world searches of complex, overlapping displays. (PsycINFO Database Record

Assessment of stereoscopic optic disc images using an autostereoscopic screen - experimental study.

BACKGROUND: Stereoscopic assessment of the optic disc morphology is an important part of the care of patients with glaucoma. The aim of this study was to assess stereoviewing of stereoscopic optic disc images using an example of the new technology of autostereoscopic screens compared to the liquid shutter goggles. METHODS: Independent assessment of glaucomatous disc characteristics and measurement of optic disc and cup parameters whilst using either an autostereoscopic screen or liquid crystal shutter goggles synchronized with a view switching display. The main outcome measures were inter-modality agreements between the two used modalities as evaluated by the weighted kappa test and Bland Altman plots. RESULTS: Inter-modality agreement for measuring optic disc parameters was good [Average kappa coefficient for vertical Cup/Disc ratio was 0.78 (95% CI 0.62-0.91) and 0.81 (95% CI 0.6-0.92) for observer 1 and 2 respectively]. Agreement between modalities for assessing optic disc characteristics for glaucoma on a five-point scale was very good with a kappa value of 0.97. CONCLUSION: This study compared two different methods of stereo viewing. The results of assessment of the different optic disc and cup parameters were comparable using an example of the newly developing autostereoscopic display technologies as compared to the shutter goggles system used. The Inter-modality agreement was high. This new technology carries potential clinical usability benefits in different areas of ophthalmic practice.