Clinical validation of eye vergence as an objective marker for diagnosis of ADHD in children

Objective: ADHD youth show poor oculomotor control. Recent research shows that attention-related eye vergence is weak in ADHD children. Method: To validate vergence as a marker to classify ADHD, we assessed the modulation in the angle of vergence of children (n = 43) previously diagnosed with ADHD while performing an attention task and compared the results with age-matched clinical controls (n = 19) and healthy peers (n = 30). Results: We observed strong vergence responses in healthy participants and weak vergence in the clinical controls. ADHD children showed no significant vergence responses. Machine-learning models classified ADHD patients (n = 21) from healthy controls (n = 21) with an accuracy of 96.3% (false positive [FP]: 5.12%; false negative [FN]: 0%; area under the curve [AUC]: 0.99) and ADHD children (n = 11) from clinical controls (n = 14) with an accuracy of 85.7% (FP: 4.5%; FN: 19.2%, AUC: 0.90). Conclusion: In combination with an attention task, vergence responses can be used as an objective marker to detect ADHD in children.Peer ReviewedPostprint (author's final draft

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

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

Studying brain development in infants by eye measurements: visual perception and visual attention

[eng] In the first years of life, there is a dramatic unfolding of cognitive abilities supported by the progressive control of gaze behaviour. The early development of oculomotor control is presumably closely tied to the maturation of the attention system. Vergence eye movements are the movements of the eyes in opposite directions, which subserve binocular vision and depth perception. Previous studies have suggested a correlation between vergence and orienting attention (Puig, Pallarés, Zapata, & Puigcerver, 2016; Solé Puig, Pérez Zapata, Aznar-Casanova, & Supèr, 2013; Super, Marco, Perez Zapata, Canete Crespillo, & Sole Puig, 2014). The neural structures involved in the vergence system, for instance the Frontal Eye Fields (FEF), Superior Colliculus (SC), pulvinar of the thalamus and Posterior Parietal Cortex (PPC) overlap with those of the attention orienting system. This is of relevance as studying how children allocate their visual attention to relevant stimuli is a direct measure of cognitive abilities. Vergence has been studied in our research group as a measure of cognitive processing (e.g. Sole Puig et al., 2013, 2015, 2016; Esposito et al., 2018, 2019; Varela et al., 2018). In these studies, vergence responses were observed during top-down and bottom-up generated shifts of visual attention, where attentional load positively correlated with the strength of the vergence response (Sole Puig et al., 2013). The notion of a role for vergence in attention is supported by the observation of a correlation of eye vergence responses with the neural activity encoding shifts of visual attention (Solé Puig et al., 2016). Besides attention, vergence relates to memory processing as well. Memorized stimuli are accompanied with stronger vergence responses when compared to stimuli that are forgotten (Sole Puig et al., 2016). These observations motivated our current studies in younger children, to contribute to a better understanding on the impact of vergence eye movements in cognitive development early on. This PhD study consists exploring the association between the changes in the angle of vergence eye movements’ and orienting attention responses in early childhood. With eye tracking methodology, Face perception and Visual Short-Term Memory (VSTM) were evaluated as fundamental milestones of cognitive development. 130 young children aged 6-36 months were recruited from two regional kindergartens. Face images versus scrambled face images on one hand, and repeated objects versus novel objects’ images on the other hand, were introduced as visual presentations, to tackle basic cognitive functions that we hypothesize are based on orienting attention. The first study addressed face processing. A series of prototypical static human face images with neutral expression were presented from a validated face database and compared it with their computerized scrambled version. We observed that vergence eye movements’ responses were enhanced to face stimuli when compared to scrambled face stimuli. The study on Visual Short-Term Memory contends with the ability to temporarily hold information and form transient representations of objects. In turn, establish whether children utilize this visual information to anticipate future events. We presented two coloured objects on screen and randomly repeated one of them and a novel one separately. We observed that for the repeated object presentation, not only did vergence response increase, but also the order of image type correlated with the enhancement in vergence modulation. Thus far, to the best of my knowledge, this is the first PhD study of its type evaluating vergence eye movements to assess attention-orienting responses in early childhood.[spa] En los primeros años de vida existe un gran despliegue de habilidades cognitivas respaldado por el control progresivo de la mirada. El desarrollo temprano del control oculomotor está asociado al desarrollo de la atención. Los movimientos oculares de vergencia consisten en el movimiento de los ojos en direcciones opuestas que dan lugar a la visión binocular y la percepción de profundidad. Previamente, hemos sugerido una correlación entre la vergencia y la orientación de la atención (Puig et al., 2016; Solé Puig et al., 2013; Super et al., 2014). Las estructuras neuronales involucradas en el sistema de vergencia, entre ellas, los campos oculares frontales, el colículo superior, el pulvinar del tálamo y la corteza parietal posterior se superponen con las del sistema de orientación de la atención. Esto es relevante ya que el estudio de cómo los niños despliegan y distribuyen su atención visual a los estímulos relevantes del entorno es una medida directa de sus capacidades cognitivas. De este modo, la orientación de la atención puede arrojar luz sobre el desarrollo cognitivo a posteriori. La vergencia ha sido estudiada en nuestro grupo de investigación como una medida del procesamiento cognitivo (Sole Puig et al., 2013, 2015, 2016; Esposito et al., 2018, 2019; Varela et al., 2018). En estos estudios, se observaron respuestas de vergencia durante los cambios en la atención visual generados de arriba hacia abajo y de abajo hacia arriba, donde la carga atencional correlacionó positivamente con la amplitud en la respuesta de vergencia (Sole Puig et al., 2013). La noción de un papel de la vergencia en la atención se basa en la observación de una correlación en las respuestas de vergencia ocular con la actividad neuronal que codifica los cambios en la atención visual (Solé Puig et al., 2016). Asimismo, la vergencia está relacionada con la memoria. Los estímulos memorizados se ven reflejados en respuestas de vergencia más pronunciadas en comparación con los estímulos no retenidos en la memoria (Sole Puig et al., 2016). Este estudio doctoral consiste en explorar la asociación entre la modulación en el ángulo de vergencia y la orientación de la atención en la infancia. Mediante la metodología de seguimiento ocular, el procesamiento de caras y la memoria visual a corto plazo (MVCP) se evaluaron como hitos fundamentales del desarrollo cognitivo. Se reclutaron 130 niños de 6 a 36 meses de edad de 2 jardines de infantes regionales. Por un lado, presentamos imágenes de caras frente a imágenes de puzles de caras, y en la otra tarea, imágenes de objetos repetidos frente a objetos nuevos. El primer estudio abordó el procesamiento facial. Una serie de imágenes estáticas prototípicas de caras humanas con expresión neutral se compararon con su versión computarizada. Observamos que las respuestas de vergencia aumentaron frente a los estímulos de caras en comparación con los estímulos de puzles de caras. Por otra parte, el estudio sobre la memoria visual a corto plazo tiene relación con la capacidad de mantener temporalmente la información y formar representaciones transitorias de objetos. Asimismo, queríamos observar si los niños utilizan esta información visual para anticipar eventos futuros. Para ello, presentamos simultáneamente dos objetos de colores en la pantalla y luego repetimos uno al azar y otro nuevo, por separado. Hemos observado un incremento en la modulación de la vergencia en el caso de los objetos repetidos y asimismo correlacionado el incremento en la vergencia con el orden de presentación de la imagen. Este es el primer estudio doctoral de su tipo que proporciona información novedosa acerca de la vergencia para evaluar las respuestas de orientación de la atención visual en la primera infancia

Clinical validation of eye vergence as an objective marker for diagnosis of ADHD in children

Objective: ADHD youth show poor oculomotor control. Recent research shows that attention-related eye vergence is weak in ADHD children. Method: To validate vergence as a marker to classify ADHD, we assessed the modulation in the angle of vergence of children (n = 43) previously diagnosed with ADHD while performing an attention task and compared the results with age-matched clinical controls (n = 19) and healthy peers (n = 30). Results: We observed strong vergence responses in healthy participants and weak vergence in the clinical controls. ADHD children showed no significant vergence responses. Machine-learning models classified ADHD patients (n = 21) from healthy controls (n = 21) with an accuracy of 96.3% (false positive [FP]: 5.12%; false negative [FN]: 0%; area under the curve [AUC]: 0.99) and ADHD children (n = 11) from clinical controls (n = 14) with an accuracy of 85.7% (FP: 4.5%; FN: 19.2%, AUC: 0.90). Conclusion: In combination with an attention task, vergence responses can be used as an objective marker to detect ADHD in children.Peer Reviewe

Clinical validation of eye vergence as an objective marker for diagnosis of ADHD in children

Objective: ADHD youth show poor oculomotor control. Recent research shows that attention-related eye vergence is weak in ADHD children. Method: To validate vergence as a marker to classify ADHD, we assessed the modulation in the angle of vergence of children (n = 43) previously diagnosed with ADHD while performing an attention task and compared the results with age-matched clinical controls (n = 19) and healthy peers (n = 30). Results: We observed strong vergence responses in healthy participants and weak vergence in the clinical controls. ADHD children showed no significant vergence responses. Machine-learning models classified ADHD patients (n = 21) from healthy controls (n = 21) with an accuracy of 96.3% (false positive [FP]: 5.12%; false negative [FN]: 0%; area under the curve [AUC]: 0.99) and ADHD children (n = 11) from clinical controls (n = 14) with an accuracy of 85.7% (FP: 4.5%; FN: 19.2%, AUC: 0.90). Conclusion: In combination with an attention task, vergence responses can be used as an objective marker to detect ADHD in childre

Eye vergence responses during an attention task in adults with ADHD and clinical controls

Objective: ADHD patients show poor oculomotor control and recent studies show that attention-related eye vergence is weak in ADHD children. We aimed to assess vergence as a potential diagnostic biomarker for ADHD in adults. Method: We assessed the modulation in the angle of vergence while performing an attention task (N = 144), comparing the results for adults previously diagnosed with ADHD (N = 108) with age-matched clinical controls (N = 36). Results: Significant differences in eye vergence response modulation between clinical controls and ADHD patients were documented. Diagnostic test accuracy was 79%. Conclusion: In combination with an attention task, eye vergence responses could be used as an objective marker to support the clinical diagnosis of adult ADHDPeer ReviewedPostprint (author's final draft

Clinical validation of eye vergence as an objective marker for diagnosis of ADHD in children

Objective: ADHD youth show poor oculomotor control. Recent research shows that attention-related eye vergence is weak in ADHD children. Method: To validate vergence as a marker to classify ADHD, we assessed the modulation in the angle of vergence of children (n = 43) previously diagnosed with ADHD while performing an attention task and compared the results with age-matched clinical controls (n = 19) and healthy peers (n = 30). Results: We observed strong vergence responses in healthy participants and weak vergence in the clinical controls. ADHD children showed no significant vergence responses. Machine-learning models classified ADHD patients (n = 21) from healthy controls (n = 21) with an accuracy of 96.3% (false positive [FP]: 5.12%; false negative [FN]: 0%; area under the curve [AUC]: 0.99) and ADHD children (n = 11) from clinical controls (n = 14) with an accuracy of 85.7% (FP: 4.5%; FN: 19.2%, AUC: 0.90). Conclusion: In combination with an attention task, vergence responses can be used as an objective marker to detect ADHD in childre