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The objective of this study is to explore the current state of research concerning the cost-effectiveness of wearable health technologies, excluding hearing aids, owing to extensive previous investigation. A systematic review was performed using PubMed, EMBASE/MEDLINE, Google Scholar, and Cumulated Index to Nursing and Allied Health Literature to search studies evaluating the cost-effectiveness of wearable health devices in terms of quality-adjusted life years and incremental cost-effectiveness ratio. The search was conducted on March 28, 2023, and the date of publication did not limit the search. The search yielded 10 studies eligible for inclusion. These studies, published between 2012 and 2023, spanned various locations globally. The studies used data from hypothetical cohorts, existing research, randomized controlled trials, and meta-analyses. They covered a diverse range of wearable technologies applied in different health care settings, including respiratory rate monitors, pedometers, fall-prediction devices, hospital-acquired pressure injury prevention monitors, seizure detection devices, heart rate monitors, insulin therapy sensors, and wearable cardioverter defibrillators. The time horizons in the cost-effectiveness analyses ranged from less than a year to a lifetime. The studies indicate that wearable technologies can increase quality-adjusted life years and be cost-effective and potentially cost-saving. However, the cost-effectiveness depends on various factors, such as the type of device, the health condition being addressed, the specific perspective of the health economic analysis, local cost and payment structure, and willingness-to-pay thresholds. The use of wearables in health care promises improving outcomes and resource allocation. However, more research is needed to fully understand the long-term benefits and to strengthen the evidence base for health care providers, policymakers, and patients.

The U.S. Food and Drug Administration has guidelines for cooling cooked foods in retail operations. Data on foodborne illness risk factors in restaurants indicate that cooling is often out of compliance with these guidelines. We sought to identify factors under the control of the operator that had a significant effect on the cooling rates of cooked foods. Minneapolis Minnesota Health Inspectors were trained in standardized operating procedures for cooling data collection. Data loggers set to appropriate time intervals and calibrated to ±0.5 °C (∼1°F) were used in data collection. Analysis was performed using the R statistical computing language version 4.2.2. Preexisting pathogen models were used to predict Log CFU increases of Clostridium perfringens or Bacillus cereus. Data from 224 recipes were recorded by inspectors between October 2018 and October 2019. Food depth had a highly significant effect (p = 8.90E−08) on cooling rate. The use of an ice bath or ice wand was also significant (p

The pharmaceutical industry is increasingly embracing laboratory automation to enhance experimental efficiency and operational resilience, particularly through the integration of automated liquid handlers (ALHs). This paper explores the integration of the low-cost Opentrons OT-2 liquid handling robot with F. Hoffmann-La Roche AG's in-house workflow orchestration software, AutoLab, to overcome barriers to lab automation. By leveraging the OT-2′s development-oriented interfaces and AutoLab's modular architecture, we achieved a user-friendly, cost-efficient, and flexible automation solution that aligns with FAIR (findable, accessible, interoperable, reusable) data principles. We demonstrate an advanced workflow development methodology, utilizing the software architecture, that facilitates the creation of two flexible pipetting protocols and medium complexity assays. This deep integration approach diminishes the learning curve for novice users while simultaneously enhancing the overall efficiency and reliability of the experimental workflow. Our findings suggest that such integrations can significantly mitigate the challenges associated with lab automation, including cost, complexity, and adaptability, paving the way for more accessible and robust automated systems in pharmaceutical research.

Current positive airway pressure devices cost NZ$800-$2500, posing a financial barrier for the estimated 1 billion individuals worldwide with sleep apnea and those researching respiratory diseases. Increasing diagnoses and research interest in the area necessitate a low-cost, easily accessible alternative. Thus, the mePAP, a high-quality, multipurpose, low-cost (∼NZ$250) positive airway pressure device, was designed and prototyped specifically for respiratory disease research, particularly for sleep apnea. The mePAP allows user customization and provides researchers with an affordable tool for testing positive airway pressure algorithms. Unlike typical commercial devices, the mePAP offers adaptability with open-source data collection and easily modifiable software for implementing and analysing different control and diagnostic algorithms. It features three control modes: constant; bilevel; and automatic; and provides pressures from 4 to 20 cmH2O, controlled via a phone app through Wi-Fi, with a mini-sensor added at the mask for increased accuracy. Validation tests showed the mePAP’s performance is comparable to a gold-standard Fisher & Paykel device, with extremely similar output pressures. The mePAP’s low cost enhances accessibility and equity, allowing researchers to test ventilation algorithms for sleep apnea and other respiratory conditions, with all data openly available for analysis. Its adaptability and multiple applications increase its usability and usefulness across various research and clinical settings.

Purpose: Our purpose was to develop a clinically intuitive and easily understandable scoring method using statistical metrics to visually determine the quality of a radiation treatment plan. Methods and Materials: Data from 111 patients with head and neck cancer were used to establish a percentile-based scoring system for treatment plan quality evaluation on both a plan-by-plan and objective-by-objective basis. The percentile scores for each clinical objective and the overall treatment plan score were then visualized using a daisy plot. To validate our scoring method, 6 physicians were recruited to assess 60 plans, each using a scoring table consisting of a 5-point Likert scale (with scores ≥3 considered passing). Spearman correlation analysis was conducted to assess the association between increasing treatment plan percentile rank and physician rating, with Likert scores of 1 and 2 representing clinically unacceptable plans, scores of 3 and 4 representing plans needing minor edits, and a score of 5 representing clinically acceptable plans. Receiver operating characteristic curve analysis was used to assess the scoring system's ability to quantify plan quality. Results: Of the 60 plans scored by the physicians, 8 were deemed as clinically acceptable; these plans had an 89.0th ± 14.5 percentile value using our scoring system. The plans needing minor edits or deemed unacceptable had more variation, with scores falling in the 62.6nd ± 25.1 percentile and 35.6th ± 25.7 percentile, respectively. The estimated Spearman correlation coefficient between the physician score and treatment plan percentile was 0.53 (P < .001), indicating a moderate but statistically significant correlation. Receiver operating characteristic curve analysis demonstrated discernment between acceptable and unacceptable plan quality, with an area under the curve of 0.76. Conclusions: Our scoring system correlates with physician ratings while providing intuitive visual feedback for identifying good treatment plan quality, thereby indicating its utility in the quality assurance process.

Background: Prolonged sitting and reduced physical activity lead to low energy expenditures. However, little is known about the joint impact of daily sitting time and physical activity on body fat distribution. We investigated the independent and joint associations of daily sitting time and physical activity with body fat among adults. Methods: This was a cross-sectional analysis of U.S. nationally representative data from the National Health and Nutrition Examination Survey 2011–2018 among adults aged 20 years or older. Daily sitting time and leisure-time physical activity (LTPA) were self-reported using the Global Physical Activity Questionnaire. Body fat (total and trunk fat percentage) was determined via dual X-ray absorptiometry. Results: Among 10,808 adults, about 54.6% spent 6 h/day or more sitting; more than one-half reported no LTPA (inactive) or less than 150 min/week LTPA (insufficiently active) with only 43.3% reported 150 min/week or more LTPA (active) in the past week. After fully adjusting for sociodemographic data, lifestyle behaviors, and chronic conditions, prolonged sitting time and low levels of LTPA were associated with higher total and trunk fat percentages in both sexes. When stratifying by LTPA, the association between daily sitting time and body fat appeared to be stronger in those who were inactive/insufficiently active. In the joint analyses, inactive/insufficiently active adults who reported sitting more than 8 h/day had the highest total (female: 3.99% (95% confidence interval (95%CI): 3.09%–4.88%); male: 3.79% (95%CI: 2.75%–4.82%)) and trunk body fat percentages (female: 4.21% (95%CI: 3.09%–5.32%); male: 4.07% (95%CI: 2.95%–5.19%)) when compared with those who were active and sitting less than 4 h/day. Conclusion: Prolonged daily sitting time was associated with increased body fat among U.S. adults. The higher body fat associated with 6 h/day sitting may not be offset by achieving recommended levels of physical activity.

Prenatal emotional distress is common in pregnant women. Altered emotional distress can occur from the very beginning to the end of pregnancy. Heart rate variability (HRV) has recently become considered to be a potentially reliable psychophysiological stress biomarker in adults. In the current study, we evaluated ultra-short-term HRV (1-minute measurement) as a psychophysiological biomarker by examining the association between HRV parameters and self-reported prenatal emotional distress among pregnant women (N = 230) across three trimesters of pregnancy. Results: Prenatal emotional distress was associated with a lower root mean square of successive differences between normal heartbeats (RMSSD), NN50, and SDNN Index among pregnant women who are in the second trimester. For women in the first and third trimester of pregnancy, prenatal emotional distress was not significantly correlated with any HRV indicators. Limitations: The cross-sectional nature of our results limits the directional expression and assessment of the relationships, and longitudinal studies that target the recruitment of more pregnant women with subtypes of emotional distress issues are also needed. Conclusions: Time-domain parameters of low HRV (associated with reduced parasympathetic activity) can potentially serve as an efficient psychophysiological biomarker for prenatal emotional distress in the second trimester of pregnancy. However, the time-domain HRV indicators in pregnant women in the first and third trimesters may be affected by other physiological and psychological fluctuations, thus decreasing the HRV biomarker’s efficiency in predicting their prenatal emotional distress.

Summary: Human genetic studies of critical COVID-19 pneumonia have revealed the essential role of type I interferon-dependent innate immunity to SARS-CoV-2 infection. Conversely, an association between the HLA-B∗15:01 allele and asymptomatic SARS-CoV-2 infection in unvaccinated individuals was recently reported, suggesting a contribution of pre-existing T cell-dependent adaptive immunity. We report a lack of association of classical HLA alleles, including HLA-B∗15:01, with pre-omicron asymptomatic SARS-CoV-2 infection in unvaccinated participants in a prospective population-based study in the United States (191 asymptomatic vs. 945 symptomatic COVID-19 cases). Moreover, we found no such association in the international COVID Human Genetic Effort cohort (206 asymptomatic vs. 574 mild or moderate COVID-19 cases and 1,625 severe or critical COVID-19 cases). Finally, in the Human Challenge Characterisation study, the three HLA-B∗15:01 individuals infected with SARS-CoV-2 developed symptoms. As with other acute primary infections studied, no classical HLA alleles favoring an asymptomatic course of SARS-CoV-2 infection were identified.

Respiratory data was collected from 20 subjects, with an even sex distribution, in the low-risk clinical unit at the University of Canterbury. Ethical consent for this trial was granted by the University of Canterbury Human Research Ethics Committee (Ref: HREC 2023/30/LR-PS). Respiratory data were collected, for each subject, over three tests consisting of: 1) increasing set PEEP from a starting point of ZEEP using a CPAP machine; 2) test 1 repeated with two simulated apnoea's (breath holds) at each set PEEP; and 3) three forced expiratory manoeuvres at ZEEP. Data were collected using a custom pressure and flow sensor device, ECG, PPG, Garmin HRM Dual heartrate belt, and a Dräeger PulmoVista 500 Electrical Impedance Tomography (EIT) machine. Subject demographic data was also collected prior to the trial, in a questionnaire, with measurement equipment available. These data aim to inform the development of pulmonary mechanics models and titration algorithms.

In this commentary paper we reflect on our experiences of conducting two qualitative public health projects in Leicester UK around health inequalities and marginalised groups during the Covid 19 pandemic in 2020 and 2021. To contextualise the commentary, we first provide information about Leicester and how and why it was disproportionately affected by the pandemic, as well as describing the origins, aims, and methodologies of the two projects. In the second half, we describe and evaluate some of the adaptations we made to our studies and conclude with suggestions for future qualitative community health research as we adapt to the post-pandemic research landscape.

This research explores the usage of sustainability in literature and presents ‘three environments’ for addressing sustainability in the Civil and Construction Engineering (CCE) disciplines. Scholars have increasingly studied sustainability and sustainable development across CCE disciplines as the importance of sustainability awareness and action in society has increased. However, the vastness of its conceptual breadth and depth in CCE research is difficult to holistically evaluate. As a result, CCE researchers often focus on specific aspects of sustainability applied to discrete contexts, or address sustainability in broad aspirational terms and guiding motivations. This research utilized a rigorous analytical corpus linguistics approach for investigating CCE-based research published between 1989 and 2021 to capture a full view of the academic discourse surrounding sustainability in CCE. The research employed collocational network analysis to enable an expansive and comprehensive study of the concept of sustainability and how it is addressed by CCE researchers. The authors created a 25,920,583-word corpus from papers published in top CCE journals related to sustainability. Significant collocates of the word sustainability were then identified using collocational analysis, and their relationships mapped through collocational network analysis to uncover dominant research areas in CCE. Observations from over 30 years of sustainability research suggests that the CCE disciplines have largely anchored to generalized notions of sustainability, such as ‘the three pillars of sustainability.’ However, deeper analysis provides a more nuanced view. We propose an alternate paradigm of three interconnected environments where CCE professionals operate, highlight criteria for decision-making, and identify primary actions for sustainability.

The COVID-19 pandemic led to an unprecedented demand for projections of disease burden and healthcare utilization under scenarios ranging from unmitigated spread to strict social distancing policies. In response, members of the Johns Hopkins Infectious Disease Dynamics Group developed flepiMoP (formerly called the COVID Scenario Modeling Pipeline), a comprehensive open-source software pipeline designed for creating and simulating compartmental models of infectious disease transmission and inferring parameters through these models. The framework has been used extensively to produce short-term forecasts and longer-term scenario projections of COVID-19 at the state and county level in the US, for COVID-19 in other countries at various geographic scales, and more recently for seasonal influenza. In this paper, we highlight how the flepiMoP has evolved throughout the COVID-19 pandemic to address changing epidemiological dynamics, new interventions, and shifts in policy-relevant model outputs. As the framework has reached a mature state, we provide a detailed overview of flepiMoP’s key features and remaining limitations, thereby distributing flepiMoP and its documentation as a flexible and powerful tool for researchers and public health professionals to rapidly build and deploy large-scale complex infectious disease models for any pathogen and demographic setup.

Purpose: MR-guided radiotherapy (MRgRT) has the advantage of utilizing high soft tissue contrast imaging to track daily changes in target and critical organs throughout the entire radiation treatment course. Head and neck (HN) stereotactic body radiation therapy (SBRT) has been increasingly used to treat localized lesions within a shorter timeframe. The purpose of this study is to examine the dosimetric difference between the step-and-shot intensity modulated radiation therapy (IMRT) plans on Elekta Unity and our clinical volumetric modulated arc therapy (VMAT) plans on Varian TrueBeam for HN SBRT. Method: Fourteen patients treated on TrueBeam sTx with VMAT treatment plans were re-planned in the Monaco treatment planning system for Elekta Unity MR-Linac (MRL). The plan qualities, including target coverage, conformity, homogeneity, nearby critical organ doses, gradient index and low dose bath volume, were compared between VMAT and Monaco IMRT plans. Additionally, we evaluated the Unity adaptive plans of adapt-to-position (ATP) and adapt-to-shape (ATS) workflows using simulated setup errors for five patients and assessed the outcomes of our treated patients. Results: Monaco IMRT plans achieved comparable results to VMAT plans in terms of target coverage, uniformity and homogeneity, with slightly higher target maximum and mean doses. The critical organ doses in Monaco IMRT plans all met clinical goals; however, the mean doses and low dose bath volumes were higher than in VMAT plans. The adaptive plans demonstrated that the ATP workflow may result in degraded target coverage and OAR doses for HN SBRT, while the ATS workflow can maintain the plan quality. Conclusion: The use of Monaco treatment planning and online adaptation can achieve dosimetric results comparable to VMAT plans, with the additional benefits of real-time tracking of target volume and nearby critical structures. This offers the potential to treat aggressive and variable tumors in HN SBRT and improve local control and treatment toxicity.

Due to the increase in human population, there is an ever-increasing demand for energy in different sectors which leads to environmental problems like climate change, rise in temperature, and global catastrophes. Cooling systems have become a very essential element in recent decades for mankind. The present system focuses on the design and fabrication of a counter-flow humidification setup which uses biomass-based charcoal as the packing material. Air velocity and water flow rate have been varied along with the density of charcoal. Output parameters such as a change in pressure (ΔP), Coefficient of performance (COP), evaporation rate (ER), humidification efficiency (HE), specific cooling capacity (SCC), and energy consumption (EC) are evaluated. Performance parameters obtained for charcoal are compared with that of standard Celdek Packing. Through experiments, it is found that humidification efficiencies for Celdek and charcoal packing are 77.45% and 57.40% respectively. The overall coefficient of performance obtained is 1.41 for charcoal and 3.17 for Celdek packing. Among the three densities which were considered, charcoal packing with a density of 400 kg/m3 exhibited higher performance with respect to COP, HE, ER, and SCC. Similarly, a water flow rate of 0.4 lpm gave a maximum performance and 0.7 lpm gave the least. It is concluded that charcoal can be considered one of the highly efficient biomass-based materials contributing to sustainable energy related to cooling applications.

Summary: Background: The aim of this study was to detail incidence rates and relative risks for severe adverse perinatal outcomes by birthweight centile categories in a large Australian cohort of late preterm and term infants. Methods: This was a retrospective cohort study of singleton infants (≥34+0 weeks gestation) between 2000 and 2018 in Queensland, Australia. Study outcomes were perinatal mortality, severe neurological morbidity, and other severe morbidity. Categorical outcomes were compared using Chi-squared tests. Continuous outcomes were compared using t-tests. Multinomial logistic regression investigated the effect of birthweight centile on study outcomes. Findings: The final cohort comprised 991,042 infants. Perinatal mortality occurred in 1944 infants (0.19%). The incidence and risk of perinatal mortality increased as birthweight decreased, peaking for infants

There are few studies related to the radionuclide remediation options, which comply to the demands of the environmentally non-destructive physical remediation methods. So far, most of the research was conducted on the phytoremediation capacity of different energy crops, as well as the established miscanthus hybrids which involved metal and heavy metal contaminants. Hence, the objective of this research was the radioecological characterization of the examined agroecosystem, including the initial source of the radionuclides (soil) as well as different miscanthus hybrids grown on the same soil. The results have shown that the radioactive content of soil was similar to the global averages. All measurements of the activity concentration of 137Cs in miscanthus samples were below the detection limits. There is also an indication that 210Pb is leaching into the lower layers (or is being taken up by miscanthus plant from the upper layers). Moreover, transfer factors (TFs) for radionuclides, as a more precise parameter for evaluating the phytoremediation potential, were calculated; the TFs were found to be very low for 226Ra (≤0.07), TFs for 40K (≤0.39) and for 232Th (≤0.21) were in the lower limits, whereas the TFs for 238U were found to be the highest (≤0.92). For 210Pb, the TFs were not calculated, since the expectation was that a significant part of the measured quantity came from the air, and not through the soil. Having in mind the sustainability and the circularity aspect of the radionuclide phytoremediation system, the appropriate management method should be applied for the disposal and utilization of the biomass contaminated with radionuclides. This research has shown that the radiological content in miscanthus is high enough and the ash content is low enough that miscanthus ash could be considered as a NORM (Naturally Occurring Radioactive Material), and it can be further used for the construction industry (i.e. concrete, tiles), in mixtures with other materials with certain limitations, similar to the utilization of ash from other sources such as coal or wood.

Summary: Anaplastic thyroid carcinoma is arguably the most lethal human malignancy. It often co-occurs with differentiated thyroid cancers, yet the molecular origins of its aggressivity are unknown. We sequenced tumor DNA from 329 regions of thyroid cancer, including 213 from patients with primary anaplastic thyroid carcinomas. We also whole genome sequenced 9 patients using multi-region sequencing of both differentiated and anaplastic thyroid cancer components. Using these data, we demonstrate thatanaplastic thyroid carcinomas have a higher burden of mutations than other thyroid cancers, with distinct mutational signatures and molecular subtypes. Further, different cancer driver genes are mutated in anaplastic and differentiated thyroid carcinomas, even those arising in a single patient. Finally, we unambiguously demonstrate that anaplastic thyroid carcinomas share a genomic origin with co-occurring differentiated carcinomas and emerge from a common malignant field through acquisition of characteristic clonal driver mutations.

Respiratory disease is a major contributor to healthcare costs, as well as increasing morbidity and early mortality. The device presented is used to simulate the effects of Chronic Obstructive Pulmonary Disease (COPD) in healthy people. The intended use is to provide data equivalent to COPD data measured from those who are ill for initial validation of respiratory mechanics models. It would thus eliminate the need to test unhealthy and/or fragile subjects, or the need for invasive or costly equipment based test methods. The device is used in conjunction with an open-access venturi-based flow sensor, to measure pressure, flow, and breath tidal volume. The device simulates the pressure and flow profiles of a person who has COPD including the non-linear increased resistance to end-exhalation and gas trapping. To achieve this non-linearity, a combination of high and low resistance outlets is used. Thus, the simulator allows the collection of patient-specific COPD-like breathing data in a non-invasive manner from healthy subjects. The device is low-cost with the majority of the parts 3D printed using a Prusa mini 3D printer and PLA filament.

The breathing dataset presented is collected from 20 healthy individuals at the University of Canterbury using a device to simulate the pressure and flow profiles of obstructive pulmonary disease. Specifically, the expiratory non-linear resistance, which generates the characteristic expiratory pressure-flow loop lobe seen in obstructive disease. Ethical consent for the trial was granted by the University of Canterbury Human Research Ethics Committee (Ref: HREC 2022/26/LR). Data was collected using an open-source data collection device connected to a Fisher and Paykel Healthcare SleepStyle SPSCAA CPAP. The trial was conducted at CPAP PEEP levels of 4 and 8 cmH2O, as well as at ZEEP (0 cmH2O) with no CPAP attached. The simulation device was a modular device connected to the expiratory pathway, consisting of a free volume diversion and fixed high resistance outlet. Three simulation levels were selected for testing, achieved by changing the size of the elastic free volume. The intended use of this dataset is for the initial validation and development of respiratory pulmonary mechanics models, using data collected from healthy people with simulated disease prior to clinical testing.

Resting breathing data was collected from 80 smokers, vapers, asthmatics, and otherwise healthy people in the low-risk clinical unit at the University of Canterbury. Subjects were asked to breathe normally through a full-face mask connected to a Fisher and Paykel Healthcare SleepStyle SPSCAA CPAP device. PEEP (Positive End-Expiratory Pressure) support was increased from 4 to 12 cmH2O in 0.5 cmH2O increments. Data was also collected during resting breathing at ZEEP (0 cmH2O) before and after the PEEP trial. The trial was conducted under University of Canterbury Human Research Ethics Committee consent (Ref: HREC 2023/04/LR-PS). Data was collected by and Dräeger PulmoVista 500 EIT machine and a custom Venturi-based pressure and flow sensor device connected in series with the CPAP and full-face mask. The outlined dataset includes pressure, flow, volume, dynamic circumference (thoracic and abdominal, and cross-sectional aeration. Subject demographic data was self-reported using a questionnaire given prior to the trial.

Telemedicine and remote monitoring are rapidly gaining momentum in health care, including in-home and postdischarge monitoring. However, remote monitoring for telemedicine teams and receiving medical centers is yet to reach emergency medical services. When transporting a critically ill patient, continuous vital sign monitoring may be helpful to enhance receiving center collaboration and change care delivery before arrival when necessary. Our primary objective was to demonstrate successful transmission and reception of real-time physiologic summary data to a hospital base station during ambulance transport using a low-energy Bluetooth wireless wearable device linked to iridium satellite communications. We completed our proof-of-concept study on 2 simulated ground ambulance transports and 1 helicopter flight in rural areas surrounding Rochester, Minnesota. Each simulated transport used Mayo Clinic–developed wearable devices paired one-to-one with a physiologic communication kit. Electrocardiographic and photoplethysmographic waveforms were processed on the wearables every 5 minutes, with vital sign data generated and transmitted to an iridium satellite and relayed to a base station network–protected computer and mobile application with real-time display of summary and location. Data and geolocation were tracked in real time with a mobile application during the simulated transport, and summary data packets were saved on Mayo Clinic servers. During the 3 simulated rural transports, all (n=7; 100%) wearables successfully captured, recorded, and transmitted raw waveform physiologic signals. All devices transmitted successfully via the iridium satellite to the base station network–protected computer and mobile application. In all, 106 (69%) of 154 transmissions were successfully processed. Our project demonstrated successful remote monitoring of physiologic vital signs during transport in rural, low–cellular signal areas. The use of live remote monitoring should be explored to understand its utility in practice and outcomes.

Background and Purpose: Auto-contouring of complex anatomy in computed tomography (CT) scans is a highly anticipated solution to many problems in radiotherapy. In this study, artificial intelligence (AI)-based auto-contouring models were clinically validated for lymph node levels and structures of swallowing and chewing in the head and neck. Materials and Methods: CT scans of 145 head and neck radiotherapy patients were retrospectively curated. One cohort (n = 47) was used to analyze seven lymph node levels and the other (n = 98) used to analyze 17 swallowing and chewing structures. Separate nnUnet models were trained and validated using the separate cohorts. For the lymph node levels, preference and clinical acceptability of AI vs human contours were scored. For the swallowing and chewing structures, clinical acceptability was scored. Quantitative analyses of the test sets were performed for AI vs human contours for all structures using overlap and distance metrics. Results: Median Dice Similarity Coefficient ranged from 0.77 to 0.89 for lymph node levels and 0.86 to 0.96 for chewing and swallowing structures. The AI contours were superior to or equally preferred to the manual contours at rates ranging from 75% to 91%; there was not a significant difference in clinical acceptability for nodal levels I-V for manual versus AI contours. Across all AI-generated lymph node level contours, 92% were rated as usable with stylistic to no edits. Of the 340 contours in the chewing and swallowing cohort, 4% required minor edits. Conclusions: An accurate approach was developed to auto-contour lymph node levels and chewing and swallowing structures on CT images for patients with intact nodal anatomy. Only a small portion of test set auto-contours required minor edits.

While current MR-Linac (MRL) treatment workflows utilize a large table overlay during CT simulation to convert indexing between the two machines, we developed a look-up-table (LUT) as an alternative approach. After populating the LUT, index conversion factors were verified at three separate table locations. The resultant root-mean-square isocenter shifts on the MRL were 0.04/0.08 cm, 0.08/0.07 cm, and 0.09/0.08 cm with/without using the table overlay during simulation in the lateral, longitudinal, and vertical directions, respectively, which is within registration tolerance. Clinical implementation of the LUT has resulted in a more efficient MRL treatment workflow while maintaining accurate patient setup.

Respiratory model-based methods require datasets containing enough dynamics to ensure model identifiability for development and validation. Rapid expiratory occlusion has been used to identify elastance and resistance within a single breath. Currently accepted practice for rapid expiratory occlusion involves a 100 ms occlusion of the expiratory pathway. This article presents a low-cost modular rapid shutter attachment to enable identification of passive respiratory mechanics. Shuttering faster than 100 ms creates rapid expiratory occlusion without the added dynamics of muscular response to shutter closure, by eliminating perceived expiratory blockage via high shutter speed. The shutter attachment fits onto a non-invasive venturi-based flow meter with separated inspiratory and expiratory pathways, established using one-way valves. Overall, these elements allow comprehensive collection of respiratory pressure and flow datasets with relatively very rapid expiratory occlusion.

Purpose: To determine the interreader agreement for reticular pseudodrusen (RPD) assessment on combined infrared reflectance (IR) and OCT imaging in the early stages of age-related macular degeneration across a range of different criteria to define their presence. Design: Interreader agreement study. Participants: Twelve readers from 6 reading centers. Methods: All readers evaluated 100 eyes from individuals with bilateral large drusen for the following: (1) the presence of RPD across a range of different criteria and (2) the number of Stage 2 or 3 RPD lesions (from 0 to ≥ 5 lesions) on an entire OCT volume scan and on a selected OCT B-scan. Supportive information was available from the corresponding IR image. Main Outcome Measures: Interreader agreement, as assessed by Gwet’s first-order agreement coefficient (AC1). Results: When evaluating an entire OCT volume scan, there was substantial interreader agreement for the presence of any RPD, any or ≥ 5 Stage 2 or 3 lesions, and ≥ 5 definite lesions on en face IR images corresponding to Stage 2 or 3 lesions (AC1 = 0.60–0.72). On selected OCT B-scans, there was also moderate-to-substantial agreement for the presence of any RPD, any or ≥ 5 Stage 2 or 3 lesions (AC1 = 0.58–0.65) and increasing levels of agreement with increasing RPD stage (AC1 = 0.08, 0.56, 0.78, and 0.99 for the presence of any Stage 1, 2, 3, and 4 lesions, respectively). There was substantial agreement regarding the number of Stage 2 or 3 lesions on an entire OCT volume scan (AC1 = 0.68), but only fair agreement for this evaluation on selected B-scans (AC1 = 0.30). Conclusions: There was generally substantial or near-substantial—but not near-perfect—agreement for assessing the presence of RPD on entire OCT volume scans or selected B-scans across a range of differing RPD criteria. These findings underscore how interreader variability would likely contribute to the variability of findings related to the clinical associations of RPD. The low levels of agreement for assessing RPD number on OCT B-scans underscore the likely challenges of quantifying RPD extent with manual grading. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

Background/objective: Pain is the most common acute symptom following radiation therapy (RT) for head and neck cancer (HNC). The multifactorial origin of RT-induced pain makes it highly challenging to manage. Multiple studies were conducted to identify genetic variants associated with cancer pain, however few of them focused on RT-induced acute pain. In this review, we summarize the potential mechanisms of acute pain after RT in HNC and identify genetic variants associated with RT-induced acute pain and relevant acute toxicities. Methods: A comprehensive search of Ovid Medline, EMBASE and Web of Science databases using terms including “Variants”, “Polymorphisms”, “Radiotherapy”, “Acute pain”, “Acute toxicity” published up to February 28, 2022, was performed by two reviewers. Review articles and citations were reviewed manually. The identified SNPs associated with RT-induced acute pain and toxicities were reported, and the molecular functions of the associated genes were described based on genetic annotation using The Human Gene Database; GeneCards. Results: A total of 386 articles were identified electronically and 8 more articles were included after manual search. 21 articles were finally included. 32 variants in 27 genes, of which 25% in inflammatory/immune response, 20% had function in DNA damage response and repair, 20% in cell death or cell cycle, were associated with RT-inflammatory pain and acute oral mucositis or dermatitis. 4 variants in 4 genes were associated with neuropathy and neuropathic pain. 5 variants in 4 genes were associated with RT-induced mixed types of post-RT-throat/neck pain. Conclusion: Different types of pain develop after RT in HNC, including inflammatory pain; neuropathic pain; nociceptive pain; and mixed oral pain. Genetic variants involved in DNA damage response and repair, cell death, inflammation and neuropathic pathways may affect pain presentation post-RT. These variants could be used for personalized pain management in HNC patients receiving RT.

A 9 m high, near full scale three-storey configurable steel frame composite floor building incorporating friction-based connections is to be tested using two linked bi-directional shake tables at the International joint research Laboratory of Earthquake Engineering (ILEE) facilities, Shanghai, China, as part of the RObust BUilding SysTem (ROBUST) project. A total of nine structural configurations are designed and detailed. To have a better understanding of the expected system behaviour, as well as effects of other structural and non-structural elements (NSEs) on the overall system response, experimental testing at component level has been conducted prior to the shake table testing. This paper presents an introduction to the ROBUST project, followed by a numerical study on one of the nine configurations of the structure, having Moment Resisting Steel Frame (MRSF) in the longitudinal direction and Concentrically Braced Frame (CBF) in the transverse direction. Hysteretic properties employed in the numerical models are validated against component test results. The predictions of the building's seismic response under selected base excitations are presented indicating the likely low damage performance of the structure.

Objectives: We aim to characterize the serial quantitative apparent diffusion coefficient (ADC) changes of the target disease volume using diffusion-weighted imaging (DWI) acquired weekly during radiation therapy (RT) on a 1.5 T MR-Linac and correlate these changes with tumor response and oncologic outcomes for head and neck squamous cell carcinoma (HNSCC) patients as part of a programmatic R-IDEAL biomarker characterization effort. Methods: Thirty patients with HNSCC who received curative-intent RT at MD Anderson Cancer Center, were included. Baseline and weekly MRI were obtained, and various ADC parameters were extracted from the regions of interest (ROIs). Baseline and weekly ADC parameters were correlated with response during and after RT, and the recurrence using the Mann-Whitney U test. The Wilcoxon signed-rank test was used to compare the weekly ADC versus baseline values. Weekly volumetric changes (Δvolume) for each ROI were correlated with ΔADC using Spearman’s Rho test. Recursive partitioning analysis (RPA) identified the optimal ΔADC threshold associated with different oncologic outcomes. Results: There was a significant rise in all ADC parameters at different time points of RT compared to baseline for both gross primary disease (GTV-P) and gross nodal disease volumes (GTV-N). The increased ADC values for GTV-P were statistically significant only for primary tumors achieving complete remission (CR) during RT. RPA identified GTV-P ΔADC 5th percentile > 13% at the mid-RT as the most significant parameter associated with primary tumors’ CR during RT (p

Pancreatic cancer remains an inauspicious malignancy with poor long-term outcomes. The majority of patients present with advanced disease; many suffer from consequences of local progression of disease, and survival rates remain unacceptably poor. Central nervous system (CNS) metastatic spread is uncommon, with leptomeningeal carcinomatosis or leptomeningeal disease (LMD) having seldom been described in the literature. Herein we report the case of a patient with metastatic PALB2-mutated pancreatic cancer who developed progressive neurologic symptoms from LMD after five years of treatment. This case and others suggest a possible link between pancreatic cancer with absent double-strand break DNA homologous recombination repair mechanisms and the development of leptomeningeal disease.

Background: Developing context-specific, evidence-informed, and implementable injury-prevention programs is challenging. Women playing in the elite Australian Football League for Women are at high risk of serious knee injuries, and no specific injury-prevention program exists. The objective of the study was to describe the collaborative process used to create a context-specific injury-prevention program. Methods: A previously used intervention-development process was modified to incorporate a partnership with the sport's governing organization and focus on engaging program implementers. The Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) Sports Setting Matrix guided program development and implementation strategies. Results: The 7-step process, aligned with the RE-AIM Sports Setting Matrix, was applied to develop the injury-prevention program and was titled Prep to Play PRO. The steps were: (Step 1) gaining organizational support and establishing a project partnership; (Step 2) using research evidence and clinical experience; (Step 3) consulting content and context experts; (Step 4) engaging the organization, experts, program implementers, and end-users to concreate the intervention and develop implementation strategies; (Step 5) testing the intervention acceptability and feasibility; (Step 6) evaluating the intervention and implementation strategies against theory; and (Step 7) obtaining feedback from early implementers and end-users. Conclusion: Engaging critical stakeholders at multiple ecological levels (organization, team, and athlete) throughout program development and implementation planning support real-world use. The processes and activities described can guide future sports injury-prevention program development and implementation.