Serial 7-Day Electrocardiogram Patch Screening for AF in High-Risk Older Women by the CHARGE-AF Score.

BACKGROUND: Asymptomatic atrial fibrillation (AF) is associated with an increased risk of stroke. The yield of serial electrocardiographic (ECG) screening for AF is unknown. OBJECTIVES: The aim of this study was to determine the frequency of AF detected by serial, 7-day ECG patch screenings in older women identified as having an elevated risk of AF according to the CHARGE (Cohorts for Heart and Aging Research in Genomic Epidemiology)-AF clinical prediction score. METHODS: Postmenopausal women with a 5-year predicted risk of new-onset AF ≥5% according to CHARGE-AF were recruited from the ongoing WHISH (Women's Health Initiative Strong and Healthy) randomized trial of a physical activity intervention. Participants with AF at baseline by self-report or medical records review were excluded. Screening with 7-day ECG patch monitors was performed at baseline, 6 months, and 12 months from study enrollment. RESULTS: On baseline monitoring, 2.5% of the cohort had AF detected, increasing to 3.7% by 6 months and 4.9% cumulatively by 12 months. Yield of patch screening was higher among participants with a higher (≥10%) CHARGE-AF score: 4.2% had AF detected at baseline, 5.9% at 6 months, and 7.2% at 12 months. Most participants with patch-identified AF never had a clinical diagnosis of AF (36 of 46 [78%]). CONCLUSIONS: Older women with an elevated CHARGE-AF score had a high prevalence of AF on 7-day ECG patch screening. Serial screening over 12 months substantially increased the detection of AF. These data can be useful in helping identify high-risk participants for enrollment in future studies of the management of asymptomatic AF.(Women's Health Initiative Silent Atrial Fibrillation Recording Study [WHISH STAR]; NCT05366803.).

Adjuvant therapy after radical trachelectomy for stage I cervical cancer.

•Radical trachelectomy is a fertility sparing option for select stage I cervical patients.•Indications for adjuvant treatment following trachelectomy are based on standard recommendations following hysterectomy.•Case report outlining specifics of imaged-guided brachytherapy as part of the adjuvant treatment after trachelectomy.

Planar IGRT dose reduction: A practical approach.

PURPOSE: To retrospectively estimate the cumulative absorbed dose (at the skin) from kilovoltage planar x-rays received by 90 patients treated on a Varian iX and to determine if that dose could be reduced without sacrificing image quality. METHODS AND MATERIALS: To estimate surface dose, measurements were obtained using the "in-air" method by varying the source-to-detector distance from 80 to 100 cm in steps of 5 cm. Energy was varied from 70 to 120 kVp. Using these data, a global equation was developed to estimate the cumulative skin dose by applying the imaging settings (kVp, mAs), patient-specific source-to-skin distance, and total number of images. To reduce the imaging dose, anterior and lateral images of RANDO phantoms were obtained using the same kVp; however, the mAs settings were systematically reduced. Contrast-to-noise ratios (CNRs) were calculated for both the standard phantom images and reduced mAs images. The mAs values were chosen to minimize skin dose while maintaining a similar CNR. Last, daily kV anterior and lateral images were obtained using these reduced mAs settings for 7 patients currently being treated with image guided radiation therapy. CNR was determined and compared with the values obtained on images taken 1 day before this change. RESULTS: Average cumulative kV imaging dose was as large as 162.2 cGy for pelvic cases with standard kVp, mAs. Other doses varied by site and technique. By lowering mAs, this dose could be reduced by 49% with only a 0.9% decrease in CNR. For the 7 patients currently being treated with image guided radiation therapy, CNR values were not statistically different (P = .79), whereas the skin dose was reduced by an average of approximately 50%. CONCLUSIONS: kV planar imaging dose reduction should be considered, given the large cumulative skin dose for certain disease sites. When mAs are reduced, planar dose reduction is clinically feasible without sacrificing image quality.

Rapid and reflexive feature-based attention.

Performance on a visual task is improved when attention is directed to relevant spatial locations or specific visual features. Spatial attention can be directed either voluntarily (endogenously) or automatically (exogenously). However, feature-based attention has only been shown to operate endogenously. Here, we show that an exogenous cue to a visual feature can lead to improved performance in visual search. Response times were measured as subjects detected or discriminated a target oval among an array of disks, each with a unique color. An uninformative colored cue was flashed at the beginning of each trial that sometimes matched the location and/or color of the target oval. Subjects detected or discriminated the target faster when the color of the cue matched the color of the target, regardless of the cue's location relative to the target. Our results suggest evidence for a previously unknown exogenous cuing mechanism for feature-based attention.

Enhanced memory for scenes presented at behaviorally relevant points in time.

The ability to remember a briefly presented scene depends on a number of factors, such as its saliency, novelty, degree of threat, or behavioral relevance to a task. Here, however, we show that the encoding of a scene into memory may depend not only on what the scene contains but also when it occurs. Participants performed an attentionally demanding target detection task at fixation while also viewing a rapid sequence of full-field photographs of urban and natural scenes. Participants were then tested on whether they recognized a specific scene from the previous sequence. We found that scenes were recognized reliably only when presented concurrently with a target at fixation. This is evidence of a mechanism where traces of a visual scene are automatically encoded into memory at behaviorally relevant points in time regardless of the spatial focus of attention.

Capture of attention to threatening stimuli without perceptual awareness.

Visual images that convey threatening information can automatically capture attention. One example is an object looming in the direction of the observer-presumably because such a stimulus signals an impending collision. A critical question for understanding the relationship between attention and conscious awareness is whether awareness is required for this type of prioritized attentional selection. Although it has been suggested that visual spatial attention can only be affected by consciously perceived events, we show that automatic allocation of attention can occur even without conscious awareness of impending threat. We used a visual search task to show that a looming stimulus on a collision path with an observer captures attention but a looming stimulus on a near-miss path does not. Critically, observers were unaware of any difference between collision and near-miss stimuli even when explicitly asked to discriminate between them in separate experiments. These results counter traditional salience-based models of attentional capture, demonstrating that in the absence of perceptual awareness, the visual system can extract behaviorally relevant details from a visual scene and automatically categorize threatening versus nonthreatening images at a level of precision beyond our conscious perceptual capabilities.

Objects on a collision path with the observer demand attention.

How observers distribute limited processing resources to regions of a scene is based on a dynamic balance between current goals and reflexive tendencies. Past research showed that these reflexive tendencies include orienting toward objects that expand as if they were looming toward the observer, presumably because this signal indicates an impending collision. Here we report that during visual search, items that loom abruptly capture attention more strongly when they approach from the periphery rather than from near the center of gaze (Experiment 1), and target objects are more likely to be attended when they are on a collision path with the observer rather than on a near-miss path (Experiment 2). Both effects are exaggerated when search is performed in a large projection dome (Experiment 3). These findings suggest that the human visual system prioritizes events that are likely to require a behaviorally urgent response.