Quantification and precision: a brief look at some ancient accounts

We explore the extent to which ancient Greek authors formulated concepts that approximate or encompass our modern notions of precision and accuracy. First, we focus on estimates and measurements of geographic features, astronomical times and positions, and weight. These raise further questions about whether the quantities reported were measured, estimated, or rounded. While ancient sources discuss the use of instruments, it is not always clear that the aim was to achieve what we would today regard as 'precision'. Next, we briefly consider round numbers, observing that they could carry symbolic meaning, while unrounded numbers could give an impression of hard-won achievement. Finally, we examine uses of the word akribeia. This is often translated as 'precision' or 'exactness', and Greek writers sometimes used akribeia to denote an ideal for their inquiries. A brief look at its uses by a number of Greek writers will on the one hand show the mismatch with our term 'precision', and on the other hand throw some light on the aims of Greek investigators.

Cross-sectional comparison of the probabilistic structure in the distribution of pitching location among baseball pitchers of different ages

The present study was a cross-sectional comparison of probabilistic structure in the distribution of pitching location among baseball pitchers of various age groups (25 elementary school (ES), 20 junior high school (JH), 15 high school (HS), and 18 college students (CL)). In the results, despite the general age-dependent variations in pitching precision, the difference was reflected not only in error 'size' but also in the 'shape' of error as it was shown by fitting 95% confidence ellipse to the two dimensional distribution of pitch location. While the precision measure as a reflection of trial-by-trial variability of release timing (major axis length of the ellipse) was constant, minor axis length of the ellipse as a reflection of variability in the pitching form of each participant demonstrated significant differences among the groups. In the ES group particularly, the trial-by-trial variability in the trajectory angle of the throwing arm was significantly correlated with the minor axis length; this correlation was far greater than those in older groups. The present study is the first to demonstrate the detailed structure of the variability of pitching location of baseball dependent on age.

Confidence estimation based on data from independent studies

The problem of finding confidence intervals based on data from several independent studies or experiments is considered. A general method of finding confidence intervals by inverting a combined test is proposed. The combined tests considered are the Fisher test, the weighted inverse normal test, the inverse chi-square test and the inverse Cauchy test. The method is illustrated for finding confidence intervals for a common mean of several normal populations, common correlation coefficient of several bivariate normal populations, common coefficient of variation, common mean of several lognormal populations, and for a common mean of several gamma populations. For each case, the confidence intervals based on the combined tests are compared with the other available approximate confidence intervals with respect to coverage probability and precision. R functions to compute all confidence intervals are provided in a supplementary file. The methods are illustrated using several practical examples.

Confidence Interval: Advantages, Disadvantages and the Dilemma of Interpretation

Confidence interval (CI) is one of the important reporting tools for research data as it not only provides valuable information about the effect size along with its width but also possible clinical significance. Unfortunately, this approach is not being utilized to its fullest extent. Determining point estimate always includes an element of uncertainty due to associated sampling error. A confidence interval may be an appropriate tool to measure this uncertainty. Further, the P value does not convey information about the magnitude of an effect and the error associated with it. Thus, in an ideal situation effect size should preferably be associated with a confidence interval to assess precision. Not only does CI let us assess likely effects but also decides whether the intervention applied could have clinical utility. In contrast, the p-value limits our option to either reject any differences that are not significant or accept those that are. However, confidence intervals are commonly misinterpreted. It is imperative to understand that the CI is not the range of effects that 95% of patients in the population exhibit. Moreover, it would also be erroneous to say that there is a 95% probability that the CI includes the true population effect. Interpretation is usually based on the context in which the confidence interval is being looked at. From a utility point of view and like other statistical tools confidence interval approach does have several advantages as well as disadvantages and is far beyond being a perfect statistical tool.

Varus/valgus stability in imageless robotic-assisted total knee arthroplasty applying three-dimensional assessment of varus/valgus stress X-rays

BACKGROUND

The postoperative varus/valgus stability assessment in stress X-rays has been established as an evaluation index. However, it is performed by the two-dimensional (2D) method rather than the three-dimensional (3D) method.

OBJECTIVE

This study aimed to identify the precision and reproducibility of measuring varus/valgus stress X-rays three-dimensionally and to examine varus/valgus stability under anesthesia in imageless robotic assisted total knee arthroplasty (rTKA).

METHODS

This prospective study analyzed 52 consecutive rTKAs (five males, 67 ± 5.3 years; 47 females, 74 ± 5.9 years). Postoperative varus/valgus stress X-rays in knee extension under anesthesia at manual maximum stress were three-dimensionally assessed by 2D-3D image matching technique using the 3D bone and component models. Varus/valgus angle between components (VV angle) in no stress, valgus stress, varus stress, medial joint opening (MJO), and lateral joint opening (LJO) were evaluated, clarifying this method's precision and reproducibility and valgus/varus stability.

RESULTS

All parameters' precision and reproducibility had <1° mean differences and high intra- and inter-class correlation coefficients. Bland-Altman plots showed no fixed and proportional bias. Non-stress VV angle, valgus VV angle, varus VV angle, MJO, and LJO were 3.6 ± 1.2°, 1.0 ± 1.4°, 7.1 ± 1.9°, 1.5 ± 1.0 mm, and 2.8 ± 2.7 mm, respectively.

CONCLUSION

This prospective study demonstrated that (1) the three-dimensional measurement method provided sufficient precision and reproducibility, and (2) the rTKAs could achieve good postoperative varus/valgus stability with a small standard deviation.

Time troubles: clocks and practices of precision in early eighteenth-century observatories

In 1736/37, Joseph-Nicolas Delisle and Jean Jacques Dortous de Mairan communicated about the clocks that would enable the astronomers of the Saint Petersburg observatory to make highly exact observations. Delisle, who was in charge of the Saint Petersburg observatory, demanded old-fashioned clocks in the manner of Huygens. Mairan, well-versed in astronomy himself, recommended equation clocks. The article uses these seemingly inappropriate preferences to discuss eighteenth-century notions of accuracy and precision in clocks. It analyses the multiple factors that influenced expectations regarding the performance of timekeeping instruments, and draws attention to handling and monitoring practices. The latter reflected the individual user's purposes and experience, but also affected the clocks' going. Furthermore, the article presents the result of a statistical analysis, which serves to evaluate the historical performance of the Saint Petersburg observatory clocks and provides a foil against which Delisle's judgement of them is examined.

Longitudinal Impacts of Precision Greenness on Alzheimer's Disease

BACKGROUND

The potential for greenness as a novel protective factor for Alzheimer's disease (AD) requires further exploration.

OBJECTIVES

This study assesses prospectively and longitudinally the association between precision greenness - greenness measured at the micro-environmental level, defined as the Census block - and AD incidence.

DESIGN

Older adults living in consistently high greenness Census blocks across 2011 and 2016 were compared to those living in consistently low greenness blocks on AD incidence during 2012-2016.

SETTING

Miami-Dade County, Florida, USA.

PARTICIPANTS

230,738 U.S. Medicare beneficiaries.

MEASUREMENTS

U.S. Centers for Medicare and Medicaid Services Chronic Condition Algorithm for AD based on ICD-9 codes, Normalized Difference Vegetation Index, age, sex, race/ethnicity, neighborhood income, and walkability.

RESULTS

Older adults living in the consistently high greenness tertile, compared to those in the consistently low greenness tertile, had 16% lower odds of AD incidence (OR=0.84, 95% CI: 0.76-0.94, p=0.0014), adjusting for age, sex, race/ethnicity, and neighborhood income. Age, neighborhood income and walkability moderated greenness' relationship to odds of AD incidence, such that younger ages (65-74), lower-income, and non-car dependent neighborhoods may benefit most from high greenness.

CONCLUSIONS

High greenness, compared to low greenness, is associated with lower 5-year AD incidence. Residents who are younger and/or who reside in lower-income, walkable neighborhoods may benefit the most from high greenness. These findings suggest that consistently high greenness at the Census block-level, may be associated with reduced odds of AD incidence at a population level.

Measurement of the Growth of the Main Commercial Rays (Raja clavata, Raja brachyura, Torpedo marmorata, Dipturus oxyrinchus) in European Waters Using Intercalibration Methods

The intercalibration of age readings represents a crucial step in the ageing procedure; the use of different sampling methods, structures, preparation techniques, and ageing criteria can significantly affect age and growth data. This study evaluated the precision and accuracy of ageing for the most important North Atlantic (NA) and Mediterranean (M) ray species, Raja clavata, Raja brachyura, Torpedo marmorata, and Dipturus oxyrinchus, through exchange exercises carried out by readers from different laboratories. In addition, growth parameters were estimated from the obtained data. A total of 663 individual batoids were analysed. R. clavata and R. brachyura samples were obtained from both the NA and the M, while vertebral centra of T. marmorata and D. oxyrinchus were only available for the M. High reading variability was observed for all four evaluated species in terms of CV, APE, and PA. D. oxyrinchus and T. marmorata showed relatively slow growth and the von Bertalanffy model with fixed t0 and Gompertz's model were, respectively, the most precise models for each of these species. In R. brachyura, females had a faster growth rate compared to combined sexes. The vbt0p proved the most precise model for describing growth in this species, and no statistical differences were found between the NO and the M. For R. clavata, the best-fitting model was the vbt0p for females and males in the NO and for females from the M, while the best-fitting model for males from the M and sexes combined for both areas was log.p. Distinct growth patterns were observed between the two study areas.

Evaluation of the Precision of Kinetic Stem Cell (KSC) Counting for Specific Quantification of Human Mesenchymal Stem Cells in Heterogeneous Tissue Cell Preparations

Kinetic stem cell (KSC) counting is a recently introduced first technology for quantifying tissue stem cells in vertebrate organ and tissue cell preparations. Previously, effective quantification of the fraction or dosage of tissue stem cells had been largely lacking in stem cell science and medicine. A general method for the quantification of tissue stem cells will accelerate progress in both of these disciplines as well as related industries like drug development. Triplicate samples of human oral alveolar bone cell preparations, which contain mesenchymal stem cells (MSCs), were used to estimate the precision of KSC counting analyses conducted at three independent sites. A high degree of intra-site precision was found, with coefficients of variation for determinations of MSC-specific fractions of 8.9% (p < 0.003), 13% (p < 0.006), and 25% (p < 0.02). The estimates of inter-site precision, 11% (p < 0.0001) and 26% (p < 0.0001), also indicated a high level of precision. Results are also presented to show the ability of KSC counting to define cell subtype-specific kinetics factors responsible for changes in the stem cell fraction during cell culture. The presented findings support the continued development of KSC counting as a new tool for advancing stem cell science and medicine.

Smartphone-Based versus Non-Invasive Automatic Oscillometric Brachial Cuff Blood Pressure Measurements: A Prospective Method Comparison Volunteer Study

Introduction: Mobile health diagnostics have demonstrated effectiveness in detecting and managing chronic diseases. This method comparison study aims to assess the accuracy and precision of the previously evaluated OptiBP™ technology over a four-week study period. This device uses optical signals recorded by placing a patient's fingertip on a smartphone's camera to estimate blood pressure (BP). Methods: In adult participants without cardiac arrhythmias and minimal interarm blood pressure difference (systolic arterial pressure (SAP) < 15 mmHg or diastolic arterial pressure (DAP) < 10 mmHg), three pairs of 30 s BP measurements with the OptiBP™ (test method) were simultaneously compared using three pairs of measurements with the non-invasive oscillometric brachial cuff (reference method) on the opposite arm over a period of four consecutive weeks at a rate of two measurements per week (one in the morning and one in the afternoon). The agreement of BP values between the two technologies was analyzed using Bland-Altman and error grid analyses. The performance of the smartphone application was investigated using the International Organization for Standardization (ISO) definitions, which require the bias ± standard deviation (SD) between two technologies to be lower than 5 ± 8 mmHg. Results: Among the 65 eligible volunteers, 53 participants had adequate OptiBP™ BP values. In 12 patients, no OptiBP™ BP could be measured due to inadequate signals. Only nine participants had known chronic arterial hypertension and 76% of those patients were treated. The mean bias ± SD between both technologies was -1.4 mmHg ± 10.1 mmHg for systolic arterial pressure (SAP), 0.2 mmHg ± 6.5 mmHg for diastolic arterial pressure (DAP) and -0.5 mmHg ± 6.9 mmHg for mean arterial pressure (MAP). Error grid analyses indicated that 100% of the pairs of BP measurements were located in zones A (no risk) and B (low risk). Conclusions: In a cohort of volunteers, we observed an acceptable agreement between BP values obtained with the OptiBPTM and those obtained with the reference method over a four-week period. The OptiBPTM fulfills the ISO standards for MAP and DAP (but not SAP). The error grid analyses showed that 100% measurements were located in risk zones A and B. Despite the need for some technological improvements, this application may become an important tool to measure BP in the future.

Evaluating Stage Motion for Automated Electron Microscopy

Precise control is an essential and elusive quality of emerging self-driving transmission electron microscopes (TEMs). It is widely understood these instruments must be capable of performing rapid, high-volume, and arbitrary movements for practical self-driving operation. However, stage movements are difficult to automate at scale, owing to mechanical instability, hysteresis, and thermal drift. Such difficulties pose major barriers to artificial intelligence-directed microscope designs that require repeatable, precise movements. To guide design of emerging instruments, it is necessary to understand the behavior of existing mechanisms to identify rate limiting steps for full autonomy. Here, we describe a general framework to evaluate stage motion in any TEM. We define metrics to evaluate stage degrees of freedom, propose solutions to improve performance, and comment on fundamental limits to automated experimentation using present hardware.

Extending cBioPortal for Therapy Recommendation Documentation in Molecular Tumor Boards: Development and Usability Study

BACKGROUND

In molecular tumor boards (MTBs), patients with rare or advanced cancers are discussed by a multidisciplinary team of health care professionals. Software support for MTBs is lacking; in particular, tools for preparing and documenting MTB therapy recommendations need to be developed.

OBJECTIVE

We aimed to implement an extension to cBioPortal to provide a tool for the documentation of therapy recommendations from MTB sessions in a secure and standardized manner. The developed extension should be embedded in the patient view of cBioPortal to enable easy documentation during MTB sessions. The resulting architecture for storing therapy recommendations should be integrable into various hospital information systems.

METHODS

On the basis of a requirements analysis and technology analysis for authentication techniques, a prototype was developed and iteratively refined through a user-centered development process. In conclusion, the tool was evaluated via a usability evaluation, including interviews, structured questionnaires, and the System Usability Scale.

RESULTS

The patient view of cBioPortal was extended with a new tab that enables users to document MTB sessions and therapy recommendations. The role-based access control was expanded to allow for a finer distinction among the rights to view, edit, and delete data. The usability evaluation showed overall good usability and a System Usability Scale score of 83.57.

CONCLUSIONS

This study demonstrates how cBioPortal can be extended to not only visualize MTB patient data but also be used as a documentation platform for therapy recommendations.

Efficacy of a WeChat-Based Multimodal Digital Transformation Management Model in New-Onset Mild to Moderate Hypertension: Randomized Clinical Trial

BACKGROUND

The advantages of multimodal digitally transformed mobile health management for patients diagnosed with mild to moderate hypertension are not yet established.

OBJECTIVE

We aim to evaluate the therapeutic benefits of a novel WeChat-based multimodal digital transforming management model in mobile health blood pressure (BP) management.

METHODS

This randomized controlled clinical trial included 175 individuals with new-onset mild to moderate hypertension who were admitted to our center between September and October 2022. The patients were randomly assigned to either the multimodal intervention group (n=88) or the usual care group (n=87). The primary composite outcome was home and office BP differences after 6 months. The major secondary outcomes were 6-month quality-of-life scores, including the self-rating anxiety scale, self-rating depression scale, and Pittsburgh Sleep Quality Index.

RESULTS

The mean home BP decreased from 151.74 (SD 8.02)/94.22 (SD 9.32) to 126.19 (SD 8.45)/82.28 (SD 9.26) mm Hg in the multimodal intervention group and from 150.78 (SD 7.87)/91.53 (SD 9.78) to 133.48 (SD 10.86)/84.45 (SD 9.19) mm Hg in the usual care group, with a mean difference in systolic blood pressure and diastolic blood pressure of -8.25 mm Hg (95% CI -11.71 to -4.78 mm Hg; P<.001) and -4.85 mm Hg (95% CI -8.41 to -1.30 mm Hg; P=.008), respectively. The mean office BP decreased from 153.64 (SD 8.39)/93.56 (SD 8.45) to 127.81 (SD 8.04)/ 82.16 (SD 8.06) mm Hg in the multimodal intervention group and from 151.48 (SD 7.14)/(91.31 (SD 9.61) to 134.92 (SD 10.11)/85.09 (SD 8.26) mm Hg in the usual care group, with a mean difference in systolic blood pressure and diastolic blood pressure of -9.27 mm Hg (95% CI -12.62 to -5.91 mm Hg; P<.001) and -5.18 mm Hg (95% CI -8.47 to -1.89 mm Hg; P=.002), respectively. From baseline to 6 months, home BP control <140/90 mm Hg was achieved in 64 (72.7%) patients in the multimodal intervention group and 46 (52.9%) patients in the usual care group (P=.007). Meanwhile, home BP control <130/80 mm Hg was achieved in 32 (36.4%) patients in the multimodal intervention group and 16 (18.4%) patients in the usual care group (P=.008). After 6 months, there were significant differences in the quality-of-life total and graded scores, including self-rating anxiety scale scores (P=.04), self-rating depression scale scores (P=.03), and Pittsburgh Sleep Quality Index scores (P<.001), in the multimodal intervention group compared with the usual care group.

CONCLUSIONS

The WeChat-based multimodal intervention model improved the BP control rates and lowered the BP levels more than the usual care approach. The multimodal digital transforming management model for hypertension represents an emerging medical practice that utilizes the individual's various risk factor profiles for primary care and personalized therapy decision-making in patients with hypertension.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2200063550; https://www.chictr.org.cn/showproj.html?proj=175816.

Upper and Lower Limbs Acute Fatigue Did Not Mitigate Male Trained Air Force Soldiers' Marksmanship

In this study, we aimed to investigate the impact of acute fatigue on pistol shooting performance among Air Force marksmen. We compared the accuracy, precision, speed-accuracy trade-off, shooting cycle time, and hits on a silhouette target among 12 Brazilian Air Force servicemen (M age = 21.5, SD - 1.6 years) under both fatigue and non-fatigue conditions in a crossover design. In the fatigued condition, the participants performed a fatigue protocol composed of side runs, vertical jumps, push-ups, running, and burpees exercises before shooting. Participants performed the countermovement jump and the plyometric push-ups tests on a contact mat before and immediately after the fatigue protocol to compare the heights achieved pre- and post-fatigue. Paired t-tests showed a significant performance reduction of 34.36% and 40.02% for the countermovement jump and plyometric push-ups, respectively, indicating that participants were fatigued in their lower and upper limbs. In the non-fatigued condition, no exercise was performed before shooting. Results indicated no significant differences between conditions on shooting precision (p = .125; ES: .54), speed-accuracy trade-off (p = .261; ES = .33), hits within the silhouette (p = .167; ES = .41), or shooting cycle times (p = .868; ES = .05); but accuracy was greater (p = .025; ES: .54) when fatigued. We concluded that overall shooting performance was not impaired by physical fatigue, and shooting accuracy appeared to be improved. Perhaps physical fatigue was not enough to impair shooting accuracy in this young adult group, as accuracy decline is expected instead when shooters are in an exhausted state. Further research is needed to confirm these findings and test this presumption.

Highly Precise Laser-Induced Breakdown Spectroscopy Analysis of Major Mineral Nutrients in Edible Salts Using Miniaturized Salt Ponds and Alternating Laser-Ablation Data Sampling

In this work, we applied a hydrophilicity-enhanced solid substrate and an alternating laser-ablation data sampling (ALADS) scheme to improve laser-induced breakdown spectroscopy (LIBS) measurement precision and demonstrated the performance in analyzing K, Mg, Ca, and S contained in commercially available edible salt products. Five edible salt products from Australia, Bolivia, France, and South Korea were dissolved in water and a tiny volume of each solution was dropped on the solid substrate, that is, a miniaturized salt pond. After being dried, the residual salt crystals distributed still inhomogeneously, but the homogeneity could be significantly improved in comparison with that from typical drop-and-dry methods. The ALADS scheme was applied to extract three precise measurements from 9798 single-shot LIBS spectra covering the entire salt pond. The measurements obtained by ALADS were found to agree well with one another regardless of the inhomogeneous distribution of salt crystals. As a result, the measurement precision was proved remarkably. Limits of detection for K, Mg, Ca, and S were estimated to be 0.64, 1.7, 14, and 530 mg/kg, respectively, which are enough to analyze those elements contained in salts typically at the level of 100 parts per million (ppm) to ∼3 wt% for the purpose of salt quality assessment.

Influence of age, training, intraoral scanner, and software version on the scan accuracy of inexperienced operators

PURPOSE

To evaluate the effect of operator age on the scan accuracy (trueness and precision) of inexperienced operators when compared with experienced operators, and how training, intraoral scanner (IOS), and software version affect scan accuracy.

MATERIAL AND METHODS

Thirty-four operators were sorted into groups: G1 (operators <25 years old, no experience), G2 (operators >40 years old, no experience), and G3 (experienced IOS operators). They conducted partial-arch scans before and after a 4-session training with two IOSs (Trios 3 and True Definition) and two software versions. These scans were compared with the reference scans obtained from conventional impressions and a laboratory scanner (IScan D103i) to evaluate trueness (mean root mean square values) and precision (standard deviation of root mean square values) with a software program (Geomagic Control X). Kruskal-Wallis and post-hoc Dunn's tests were used to evaluate the effect of age on the scan accuracy of inexperienced groups when compared with experienced operators, while the effect of training, IOS, and software version on scan accuracy was evaluated with Wilcoxon or Mann-Whitney U tests (α = 0.05).

RESULTS

Before training, G1 and G2 scans had similar accuracy (p ≥ 0.065). After training, G1 scans had higher accuracy when IOS data was pooled and had higher precision with TD (p ≤ 0.004). Training increased the scan accuracy (p < 0.001), while newer software increased the trueness of inexperienced operator scans (p = 0.015).

CONCLUSIONS

Age affected the scan accuracy of inexperienced operators after training, indicating that extended training may be required for older operators. Training increased the scan accuracy, and newer software increased the trueness of inexperienced operator scans.

Beyond the Scalpel: A Tapestry of Surgical Safety, Precision, and Patient Prosperity

In modern surgical practice, the focus extends beyond simply making and closing incisions. We aim to investigate the various complex aspects that redefine the criteria for achieving effective surgical outcomes. This narrative combines current knowledge, integrating practical experiences and academic viewpoints to comprehend the changing field of surgical care thoroughly. The tapestry explores the detailed aspects of surgical safety, examining the most recent progress in protocols, technology, and team dynamics that strive to reduce procedural risks. Examining precision in surgery, this narrative goes beyond conventional limits to explore the incorporation of advanced technologies, such as robotics and navigational systems. The complex interplay between the surgeon's proficiency and these technology aids is crucial in attaining unparalleled accuracy and favorable patient results. The focal point of this investigation is the patient's well-being, encompassing postoperative care, rehabilitation, and long-term health. Actual accounts from surgical procedures highlight the significant influence of comprehensive patient-centered methods, emphasizing the crucial need for empathy, communication, and individualized care plans in promoting healing and adaptability. As we explore this complex situation, the combination of real-life stories and academic discussions creates a clear and detailed image of a surgical environment that goes far beyond the boundaries of the operating room. "Beyond the Scalpel" seeks to engage practitioners, scholars, and stakeholders in a conversation that redefines the criteria for surgical success. It aims to establish a new benchmark that combines safety, precision, and patient well-being, ultimately shaping the future of surgical practice.

CAD-CAM and analog occlusal splints comparison based on the amount of occlusal adjustments. 3D analysis of the volumetric changes: A pilot study

OBJECTIVE

To evaluate the volumetric changes on occlusal surface of computer-aided design and computer-aided manufacturing (CAD-CAM) occlusal devices fabricated following a fully digital workflow after occlusal adjustment, compared to those fabricated with an analog workflow.

MATERIALS AND METHODS

Eight participants were included in this clinical pilot study, receiving two different occlusal devices fabricated with two different workflows, fully analog and fully digital. Every occlusal device was scanned before and after the occlusal adjustments to compare the volumetric changes using a reverse engineering software program. Moreover, three independent evaluators assessed a semi-quantitative and qualitative comparison using visual analog scale and dichotomous evaluation. The Shapiro-Wilk test was performed to validate normal distribution assumption, and a dependent t-Student test for paired variables was used to determine statistically significant differences (p-value < 0.05).

RESULTS

The root mean square value was extracted from the 3-Dimensional (3D) analysis of the occlusal devices. The average values of the root mean square were higher for the analogic technique (0.23 ± 0.10 mm) than the digital technique (0.14 ± 0.07 mm) but the differences were not statistically significant (paired t-Student test; p = 0.106) between the two fabrication techniques. The semiquantitative visual analog scale values between the impression for the digital (5.08 ± 2.4 cm) and analog (3.80 ± 3.3 cm) technique were significant (p < 0.001), and statistically significant differences values were assessed for evaluator 3 compared to the other evaluators (p < 0.05). However, the three evaluators agreed on the qualitative dichotomous evaluation in 62% of the cases, and at least two evaluators agreed in 100% of the evaluations.

CONCLUSIONS

Occlusal devices fabricated following a fully digital workflow resulted in fewer occlusal adjustments, as they could be a valid alternative to those fabricated following an analog workflow.

CLINICAL SIGNIFICANCE

Fabricated occlusal devices following a fully digital workflow could have some advantages over analog workflow such reduce occlusal adjustments at delivery appointment, which can result in reduced chair time and therefore increased comfort for the patient and clinician.

Recalling gist memory depends on CA1 hippocampal neurons for lifetime retention and CA3 neurons for memory precision

Why some of us remember events more clearly than others and why memory loses precision over time is a major focus in memory research. Here, we show that the recruitment of specific neuroanatomical pathways within the medial temporal lobe (MTL) of the brain defines the precision of the memory recalled over the lifespan. Using optogenetics, neuronal activity mapping, and studying recent to very remote memories, we report that the hippocampal subfield CA1 is necessary for retrieving the gist of events and receives maximal support from MTL cortical areas (MEC, LEC, PER, and POR) for recalling the most remote memories. In contrast, reduction of CA3's activity alone coincides with the loss of memory precision over time. We propose that a shift between specific MTL subnetworks over time might be a fundamental mechanism of memory consolidation.

Establishing the Need for Anticipatory Symptom Guidance and Networked Models of Disease in Adaptive Family Management Among Children With Medical Complexity: Qualitative Study

BACKGROUND

Caregivers of children with medical complexity navigate complex family management tasks for their child both in the hospital and home-based setting. The roles and relationships of members of their social network and the dynamic evolution of these family management tasks have been underexamined.

OBJECTIVE

The purpose of this study was to explore the structures and processes of family management among caregivers of children with medical complexity, with a focus on the underlying dynamic nature of family management practices and the role of members of their social network.

METHODS

This study used a qualitative approach to interview caregivers of children with medical complexity and members of their social network. Caregivers of children with medical complexity were recruited through an academic Children's Hospital Complex Care Clinic in the mid-Atlantic region and interviewed over a period of 1 to 3 days. Responses were analyzed using constructivist grounded theory and situational analysis to construct a new conceptual model. Only caregiver responses are reported here.

RESULTS

In total, 20 caregivers were included in this analysis. Caregiver perspectives revealed the contextual processes that allowed for practices of family management within the setting of rapidly evolving symptoms and health concerns. The dynamic and adaptive nature of this process is a key underlying action supporting this novel conceptual model. The central themes underpinning the adaptive family management model include symptom cues, ongoing surveillance, information gathering, and acute on chronic health concerns. The model also highlights facilitators and threats to successful family management among children with medical complexity and the networked relationship among the structures and processes.

CONCLUSIONS

The adaptive family management model provides a basis for further quantitative operationalization and study. Previously described self- or family management frameworks do not account for the underlying dynamic nature of the disease trajectory and the developmental stage progression of the child or adolescent, and our work extends existing work. For future work, there is a defined role for technology-enhanced personalized approaches to home-based monitoring. Due to the disparities caregivers and the children in this population already experience, technology-enhanced approaches must be built alongside key stakeholders with an equity orientation to technology co-development.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/14810.

Precision endoscopy in colorectal polyps' characterization and planning of endoscopic therapy

Precision endoscopy in the management of colorectal polyps and early colorectal cancer has emerged as the standard of care. It includes optical characterization of polyps and estimation of submucosal invasion depth of large nonpedunculated colorectal polyps to select the appropriate endoscopic resection modality. Over time, several imaging modalities have been implemented in endoscopic practice to improve optical performance. Among these, image-enhanced endoscopy systems and magnification endoscopy represent now well-established tools. New advanced technologies, such as endocytoscopy and confocal laser endomicroscopy, have recently shown promising results in predicting the histology of colorectal polyps. In recent years, artificial intelligence has continued to enhance endoscopic performance in the characterization of colorectal polyps, overcoming the limitations of other imaging modes. In this review we retrace the path of precision endoscopy, analyzing the yield of various endoscopic imaging techniques in personalizing management of colorectal polyps and early colorectal cancer.

Cancer Diagnosis through Contour Visualization of Gene Expression Leveraging Deep Learning Techniques

Prompt diagnostics and appropriate cancer therapy necessitate the use of gene expression databases. The integration of analytical methods can enhance detection precision by capturing intricate patterns and subtle connections in the data. This study proposes a diagnostic-integrated approach combining Empirical Bayes Harmonization (EBS), Jensen-Shannon Divergence (JSD), deep learning, and contour mathematics for cancer detection using gene expression data. EBS preprocesses the gene expression data, while JSD measures the distributional differences between cancerous and non-cancerous samples, providing invaluable insights into gene expression patterns. Deep learning (DL) models are employed for automatic deep feature extraction and to discern complex patterns from the data. Contour mathematics is applied to visualize decision boundaries and regions in the high-dimensional feature space. JSD imparts significant information to the deep learning model, directing it to concentrate on pertinent features associated with cancerous samples. Contour visualization elucidates the model's decision-making process, bolstering interpretability. The amalgamation of JSD, deep learning, and contour mathematics in gene expression dataset analysis diagnostics presents a promising pathway for precise cancer detection. This method taps into the prowess of deep learning for feature extraction while employing JSD to pinpoint distributional differences and contour mathematics for visual elucidation. The outcomes underscore its potential as a formidable instrument for cancer detection, furnishing crucial insights for timely diagnostics and tailor-made treatment strategies.

Development of precision of non-symbolic arithmetic operations in 4-6-year-old children

Children can represent the approximate quantity of sets of items using the Approximate Number System (ANS), and can perform arithmetic-like operations over ANS representations. Previous work has shown that the representational precision of the ANS develops substantially during childhood. However, less is known about the development of the operational precision of the ANS. We examined developmental change in the precision of the solutions to two non-symbolic arithmetic operations in 4-6-year-old U.S. children. We asked children to represent the quantity of an occluded set (Baseline condition), to compute the sum of two sequentially occluded arrays (Addition condition), or to infer the quantity of an addend after observing an initial array and then the array incremented by the unknown addend (Unknown-addend condition). We measured the precision of the solutions of these operations by asking children to compare their solutions to visible arrays, manipulating the ratio between the true quantity of the solution and the comparison array. We found that the precision of ANS representations that were not the result of operations (in the Baseline condition) was higher than the precision of solutions to ANS operations (in the Addition and Unknown-addend conditions). Further, we found that precision in the Baseline and Addition conditions improved significantly between 4 and 6 years, while precision in the Unknown-Addend condition did not. Our results suggest that ANS operations may inject "noise" into the representations they operate over, and that the development of the precision of different operations may follow different trajectories in childhood.

Fuzzy Modeling Development for Lettuce Plants Irrigated with Magnetically Treated Water

Due to the worldwide water supply crisis, sustainable strategies are required for a better use of this resource. The use of magnetic water has been shown to have potential for improving irrigation efficacy. However, a lack of modelling methods that correspond to the experimental results and minimize error is observed. This study aimed to estimate the replacement rates of magnetic water provided by irrigation for lettuce production using a mathematical model based on fuzzy logic and to compare multiple polynomial regression analysis and the fuzzy model. A greenhouse study was conducted with lettuce using two types of water, magnetic water (MW) and conventional water (CW), and five irrigation levels (25, 50, 75, 100 and 125%) of crop evapotranspiration. Plant samples for biometric lettuce were taken at 14, 21, 28 and 35 days after transplanting. The data were analyzed via multiple polynomial regression and fuzzy mathematical modeling, followed by an inference of the models and a comparison between the methods. The highest biometric values for lettuce were observed when irrigated with MW during the different phenological stage evaluated. The fuzzy model provided a more exact adjustment when compared to the multiple polynomial regressions.