Journal of Biomechanical Engineering Considerations in Applying Dynamic Programming Filters to the Smoothing of Noisy Data

Introduction The problem of extracting derivative information from noisy data occurs in many disciplines but is particularly prevalent in the field of biomechanics, where one often wishes to extract information about limb velocities and accelerations from data generated by camera-based kinematic tracking systems, which of necessity report only position information; all higher derivatives must therefore be deduced by operations upon these position histories. The algorithm presented by Dohrmann, Busby, and Trujillo [1], which selects the optimal smoothing parameter for a non-natural cubic spline interpolation of the noisy data, has proven particularly useful in our laborator

Brief intervention to reduce risky drinking in pregnancy: study protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Risky drinking in pregnancy by UK women is likely to result in many alcohol-exposed pregnancies. Studies from the USA suggest that brief intervention has promise for alcohol risk reduction in antenatal care. However, further research is needed to establish whether this evidence from the USA is applicable to the UK. This pilot study aims to investigate whether pregnant women can be recruited and retained in a randomized controlled trial of brief intervention aimed at reducing risky drinking in women receiving antenatal care.</p> <p>Methods</p> <p>The trial will rehearse the parallel-group, non-blinded design and procedures of a subsequent definitive trial. Over 8 months, women aged 18 years and over (target number 2,742) attending their booking appointment with a community midwife (n = 31) in north-east England will be screened for alcohol consumption using the consumption questions of the Alcohol Use Disorders Identification Test (AUDIT-C). Those screening positive, without a history of substance use or alcohol dependence, with no pregnancy complication, and able to give informed consent, will be invited to participate in the trial (target number 120). Midwives will be randomized in a 1:1 ratio to deliver either treatment as usual (control) or structured brief advice and referral for a 20-minute motivational interviewing session with an alcohol health worker (intervention). As well as demographic and health information, baseline measures will include two 7-day time line follow-back questionnaires and the EuroQoL EQ-5D-3 L questionnaire. Measures will be repeated in telephone follow-ups in the third trimester and at 6 months post-partum, when a questionnaire on use of National Health Service and social care resources will also be completed. Information on pregnancy outcomes and stillbirths will be accessed from central health service records before the follow-ups. Primary outcomes will be rates of eligibility, recruitment, intervention delivery, and retention in the study population, to inform power calculations for a definitive trial. The health-economics component will establish how cost-effectiveness will be assessed, and examine which data on health service resource use should be collected in a main trial. Participants’ views on instruments and procedures will be sought to confirm their acceptability.</p> <p>Discussion</p> <p>The study will produce a full trial protocol with robust sample-size calculations to extend evidence on effectiveness of screening and brief intervention.</p> <p>Trial Registration</p> <p>Current Controlled Trials ISRCTN43218782</p

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Modeling and design of robotized tools and milling techniques for total knee arthroplasty

La chirurgie assistée par ordinateur (CAO) a amené une valeur ajoutée significative aux interventions médicales, en fournissant des outil: de mesure permettant aux chirurgiens de quantifier et contrôler leurs gestes. Pour la pose de prothèse totale de genou (PTG), la CAO a réduit de manière significative les variations de position, paramètres directement corrèlés aux échecs précoces nécessitant une chirurgie de reprise. Les cliniciens restent néanmoins demandeurs d'une précision accrue et de possibilités additionnelles, qui semblent ne pouvoi être offertes que par de la robotique ou des 'outils intelligents' couplés à de la navigation. Un nouvel outil robotique dédié au fraisage de l'os pour les chirurgies des PTG a été développé. Notre robot miniature, appelé PRAXITELES, est fixé directement sur l'os sur l'un des côté du genou, il positionne avec précision un guide de fraisage qui permet au chirurgien de faire manuellement les coupes. Le fraisage manuel est un acte difficile, intrinsèquement instable; c'est pourquoi un modèle prédictif du processus de fraisage de l'os a été formulé, et des tests ont été menés, pour mieux comprendre et pour améliorer ce processus. La physique de la coupe osseuse a d'abord été étudiée dans le cas le plus simple: coupe à grande vitesse orthogonale (20) et oblique (3D). Les résultats ont ensuite été intégrés dans un modèle flexible pour la prédiction des forces de fraisage comme fonction des paramètres chirurgicaux. A partir de l'analyse des forces et de la stabilité, nous faisons des recommandations sur les techniques de fraisage optimales et sur le choix des outils. Des résultats expérimentaux sur cadavre sont très encourageants.GRENOBLE1-BU Sciences (384212103) / SudocSudocFranceF

R.N.: Enhancement of bone surface visualization from 3D ultrasound based on local phase information

Identification and localization of bone surfaces in ultrasound (US) images is an essential step in US-based image guided orthopedic procedures. However, US images often depict bones poorly compared to other medical imaging modalities, such as computed tomography (CT) or magnetic resonance (MR), because of speckle, reverberation, shadowing and other artifacts. As a result, accurate, robust and automatic localization of bone in US images remains a challenge. In this paper, we propose the use of phase congruency, a feature invariant to changes in image brightness or contrast, to enhance bone surface localization and visualization in 3D US images. The potential of the method is demonstrated through experiments in vitro and in vivo, with the results compared to conventional gradient- and edge-based bone localization approaches. These preliminary results show good performance of the proposed technique, suggesting it has promise in a clinical setting

Augmented reality visualisation for orthopaedic surgical guidance with pre- and intra-operative multimodal image data fusion

Augmented reality (AR) has proven to be a useful, exciting technology in several areas of healthcare. AR may especially enhance the operator's experience in minimally invasive surgical applications by providing more intuitive and naturally immersive visualisation in those procedures which heavily rely on three-dimensional (3D) imaging data. Benefits include improved operator ergonomics, reduced fatigue, and simplified hand–eye coordination. Head-mounted AR displays may hold great potential for enhancing surgical navigation given their compactness and intuitiveness of use. In this work, the authors propose a method that can intra-operatively locate bone structures using tracked ultrasound (US), registers to the corresponding pre-operative computed tomography (CT) data and generates 3D AR visualisation of the operated surgical scene through a head-mounted display. The proposed method deploys optically-tracked US, bone surface segmentation from the US and CT image volumes, and multimodal volume registration to align pre-operative to the corresponding intra-operative data. The enhanced surgical scene is then visualised in an AR framework using a HoloLens. They demonstrate the method's utility using a foam pelvis phantom and quantitatively assess accuracy by comparing the locations of fiducial markers in the real and virtual spaces, yielding root mean square errors of 3.22, 22.46, and 28.30 mm in the x, y, and z directions, respectively