Managing Circadian Disruption due to Hospitalization: A Pilot Randomized Controlled Trial of the CircadianCare Inpatient Management System

The objective of the present study was to test the effects of an inpatient management system (CircadianCare) aimed at limiting the negative impact of hospitalization on sleep by enhancing circadian rhythmicity. Fifty inpatients were randomized to either CircadianCare (n = 25; 18 males, 62.4 ± 1.9 years) or standard of care (n = 25; 14 males, 64.5 ± 2.3 years). On admission, all underwent a full sleep-wake evaluation; they then completed daily sleep diaries and wore an actigraph for the whole length of hospitalization. On days 1 (T0), 7 (T1), and 14 (T2, if still hospitalized), salivary melatonin for dim light melatonin onset (DLMO) and 24-h skin temperature were recorded. In addition, environmental noise, temperature, and illuminance were monitored. Patients in the CircadianCare arm followed 1 of 3 schedules for light/dark, meal, and physical activity timings, based on their diurnal preference/habits. They wore short-wavelength-enriched light-emitting glasses for 45 min after awakening and short-wavelength light filter shades from 18:00 h until sleep onset. While the first, primary registered outcome (reduced sleep-onset latency on actigraphy or diary) was not met, based on sleep diaries, there was a trend (0.05 < p < 0.1) toward an advance in bedtime for CircadianCare compared to standard of care patients between T0 and T1. Similarly, DLMO time significantly advanced in the small group of patients for whom it could be computed on both occasions, with untreated ones starting from earlier baseline values. Patients sleeping near the window had significantly higher sleep efficiency, regardless of treatment arm. As noise fluctuation increased, so did the number of night awakenings, regardless of treatment arm. In conclusion, the CircadianCare management system showed positive results in terms of advancing sleep timing and the circadian rhythm of melatonin. Furthermore, our study identified a combination of environmental noise and lighting indices, which could be easily modulated to prevent hospitalization-related insomnia.

Epistemic misalignments in microbiome research

We argue that microbiome research should be more reflective on the methods that it relies on to build its datasets due to the danger of facing a methodological problem which we call "epistemic misalignment." An epistemic misalignment occurs when the method used to answer specific scientific questions does not track justified answers, due to the material constraints imposed by the very method. For example, relying on 16S rRNA to answer questions about the function of the microbiome generates epistemic misalignments, due to the different temporal scales that 16S rRNA provides information about and the temporal scales that are required to know about the functionality of some microorganisms. We show how some of these exist in contemporary microbiome science and urge microbiome scientists to take some measures to avoid them, as they may question the credibility of the field as a whole.

Sensor Fusion for Underwater Vehicle Navigation Compensating Misalignment Using Lie Theory

This paper presents a sensor fusion method for navigation of unmanned underwater vehicles. The method combines Lie theory into Kalman filter to estimate and compensate for the misalignment between the sensors: inertial navigation system and Doppler Velocity Log (DVL). In the process and measurement model equations, a 3-dimensional Euclidean group (SE(3)) and 3-sphere space (S3) are used to express the pose (position and attitude) and misalignment, respectively. SE(3) contains position and attitude transformation matrices, and S3 comprises unit quaternions. The increments in pose and misalignment are represented in the Lie algebra, which is a linear space. The use of Lie algebra facilitates the application of an extended Kalman filter (EKF). The previous EKF approach without Lie theory is based on the assumption that a non-differentiable space can be approximated as a differentiable space when the increments are sufficiently small. On the contrary, the proposed Lie theory approach enables exact differentiation in a differentiable space, thus enhances the accuracy of the navigation. Furthermore, the convergence and stability of the internal parameters, such as the Kalman gain and measurement innovation, are improved.

Controls, comparator arms, and designs for critical care comparative effectiveness research: It's complicated

BACKGROUND

Comparative effectiveness research is meant to determine which commonly employed medical interventions are most beneficial, least harmful, and/or most costly in a real-world setting. While the objectives for comparative effectiveness research are clear, the field has failed to develop either a uniform definition of comparative effectiveness research or an appropriate set of recommendations to provide standards for the design of critical care comparative effectiveness research trials, spurring controversy in recent years. The insertion of non-representative control and/or comparator arm subjects into critical care comparative effectiveness research trials can threaten trial subjects' safety. Nonetheless, the broader scientific community does not always appreciate the importance of defining and maintaining critical care practices during a trial, especially when vulnerable, critically ill populations are studied. Consequently, critical care comparative effectiveness research trials sometimes lack properly constructed control or active comparator arms altogether and/or suffer from the inclusion of "unusual critical care" that may adversely affect groups enrolled in one or more arms. This oversight has led to critical care comparative effectiveness research trial designs that impair informed consent, confound interpretation of trial results, and increase the risk of harm for trial participants.

METHODS/EXAMPLES

We propose a novel approach to performing critical care comparative effectiveness research trials that mandates the documentation of critical care practices prior to trial initiation. We also classify the most common types of critical care comparative effectiveness research trials, as well as the most frequent errors in trial design. We present examples of these design flaws drawn from past and recently published trials as well as examples of trials that avoided those errors. Finally, we summarize strategies employed successfully in well-designed trials, in hopes of suggesting a comprehensive standard for the field.

CONCLUSION

Flawed critical care comparative effectiveness research trial designs can lead to unsound trial conclusions, compromise informed consent, and increase risks to research subjects, undermining the major goal of comparative effectiveness research: to inform current practice. Well-constructed control and comparator arms comprise indispensable elements of critical care comparative effectiveness research trials, key to improving the trials' safety and to generating trial results likely to improve patient outcomes in clinical practice.

Varus-valgus Alignment of Humeral Short Stem in Reverse Total Shoulder Arthroplasty: Does It Really Matter?

BACKGROUND

The utilization of short humeral stems in reverse total shoulder arthroplasty (RTSA) has gained attention in recent times. However, concerns regarding the risk of misalignment during implant insertion are associated with their use.

METHODS

Eight fresh-frozen cadaveric shoulders were prepared for dissection and biomechanical testing. A bespoke humeral implant was fabricated to facilitate assessment of neutral, varus, and valgus alignments using a single stem, and 10° was established as the maximum permissible angle for misalignments. Shift in humerus position and changes in deltoid length attributable to misalignments relative to the neutral position were evaluated using a Microscribe 3DLx system. The impingement-free range of motion (IFROM), encompassing abduction, adduction, internal rotation (IR), and external rotation (ER), was gauged using a digital goniometer. The capacity for abduction was evaluated at maximal abduction angles under successive loading on the middle deltoid. A specialized traction system coupled with a force transducer was employed to measure anterior dislocation forces.

RESULTS

Relative to the neutral alignment, valgus alignment resulted in a more distal (10.5 ± 2.4 mm) and medial (8.3 ± 2.2 mm) translation of the humeral component, whereas the varus alignment resulted in the humerus shifting more superiorly (11.2 ± 1.3 mm) and laterally (9.9 ± 0.9 mm) at 0° abduction. The valgus alignment exhibited the highest abduction angle than neutral alignment (86.2°, P<0.001). Conversely, the varus alignment demonstrated significantly higher adduction (18.4±7.4°, P<0.001), IR (68.9±15.0°, P=0.014), and ER (45.2±10.5°, P=0.002) at 0° abduction compared to the neutral alignments. Anterior dislocation forces were considerably lower (23.8N) in the varus group compared to the neutral group at 0°ER (P=0.047). Additionally, abduction capability was markedly higher in varus alignment at low deltoid loads than the neutral alignment (5N, P=0.009; 7.5N, P=0.007).

CONCLUSIONS

The varus position enhances rotational ROM but increases instability, while the valgus position does not significantly impact ROM or instability compared to the neutral position.

The efficacy of part-time patching treatment for intermittent exotropia on different age groups

BACKGROUND

Intermittent exotropia (IXT) is one of the most common forms of strabismus usually seen in the pediatric age group, the prevalence of IXT is higher in Africa and the Middle East. IXT treatment strategies include both surgical and non-surgical methods, non-surgical management is preferred in general as it is less invasive and avoids the risks associated with surgery and anesthesia.

AIMS

This study aims to determine the effectiveness of patching therapy for the treatment of IXT in different age groups and to compare the success of patching therapy in preventing surgery in IXT patients in different age groups.

METHODOLOGY

A retrospective chart review was conducted from September 2022 until February 2023 at King Abdulaziz University Hospital in Riyadh. The data was collected retrospectively from electronic medical records from 2016 to 2021 of all patients diagnosed with IXT and were managed by patching therapy fitting the inclusion criteria.

RESULTS

A total of 76 patients with IXT enrolled in the study with 56.5% of the participants were older than 7 years old. Overall, there was no improvement in the angle of deviation but 34% of patients had improved control over the follow-up period. 55.3% of the participants didn't require surgery. Younger age, longer duration of patching per month, and good compliance were significantly associated with treatment success.

CONCLUSION

Younger age groups were more likely to benefit from patching therapy than older age groups, and good compliance to patching therapy is an important factor in preventing the need for surgery.

Understanding Error Patterns: An Analysis of Alignment Errors in Rigid 3D Body Scans

Three-dimensional body scanners are attracting increasing interest in various application areas. To evaluate their accuracy, their 3D point clouds must be compared to a reference system by using a reference object. Since different scanning systems use different coordinate systems, an alignment is required for their evaluation. However, this process can result in translational and rotational misalignment. To understand the effects of alignment errors on the accuracy of measured circumferences of the human lower body, such misalignment is simulated in this paper and the resulting characteristic error patterns are analyzed. The results show that the total error consists of two components, namely translational and tilt. Linear correlations were found between the translational error (R2 = 0.90, … 0.97) and the change in circumferences as well as between the tilt error (R2 = 0.55, … 0.78) and the change in the body's mean outline. Finally, by systematic analysis of the error patterns, recommendations were derived and applied to 3D body scans of human subjects resulting in a reduction of error by 67% and 84%.

Circadian regulation of liver metabolism: experimental approaches in human, rodent, and cellular models

Circadian rhythms are endogenous oscillations with approximately a 24-h period that allow organisms to anticipate the change between day and night. Disruptions that desynchronize or misalign circadian rhythms are associated with an increased risk of cardiometabolic disease. This review focuses on the liver circadian clock as relevant to the risk of developing metabolic diseases including nonalcoholic fatty liver disease (NAFLD), insulin resistance, and type 2 diabetes (T2D). Many liver functions exhibit rhythmicity. Approximately 40% of the hepatic transcriptome exhibits 24-h rhythms, along with rhythms in protein levels, posttranslational modification, and various metabolites. The liver circadian clock is critical for maintaining glucose and lipid homeostasis. Most of the attention in the metabolic field has been directed toward diet, exercise, and rather little to modifiable risks due to circadian misalignment or disruption. Therefore, the aim of this review is to systematically analyze the various approaches that study liver circadian pathways, targeting metabolic liver diseases, such as diabetes, nonalcoholic fatty liver disease, using human, rodent, and cell biology models.NEW & NOTEWORTHY Over the past decade, there has been an increased interest in understanding the intricate relationship between circadian rhythm and liver metabolism. In this review, we have systematically searched the literature to analyze the various experimental approaches utilizing human, rodent, and in vitro cellular approaches to dissect the link between liver circadian rhythms and metabolic disease.

AFTR: A Robustness Multi-Sensor Fusion Model for 3D Object Detection Based on Adaptive Fusion Transformer

Multi-modal sensors are the key to ensuring the robust and accurate operation of autonomous driving systems, where LiDAR and cameras are important on-board sensors. However, current fusion methods face challenges due to inconsistent multi-sensor data representations and the misalignment of dynamic scenes. Specifically, current fusion methods either explicitly correlate multi-sensor data features by calibrating parameters, ignoring the feature blurring problems caused by misalignment, or find correlated features between multi-sensor data through global attention, causing rapidly escalating computational costs. On this basis, we propose a transformer-based end-to-end multi-sensor fusion framework named the adaptive fusion transformer (AFTR). The proposed AFTR consists of the adaptive spatial cross-attention (ASCA) mechanism and the spatial temporal self-attention (STSA) mechanism. Specifically, ASCA adaptively associates and interacts with multi-sensor data features in 3D space through learnable local attention, alleviating the problem of the misalignment of geometric information and reducing computational costs, and STSA interacts with cross-temporal information using learnable offsets in deformable attention, mitigating displacements due to dynamic scenes. We show through numerous experiments that the AFTR obtains SOTA performance in the nuScenes 3D object detection task (74.9% NDS and 73.2% mAP) and demonstrates strong robustness to misalignment (only a 0.2% NDS drop with slight noise). At the same time, we demonstrate the effectiveness of the AFTR components through ablation studies. In summary, the proposed AFTR is an accurate, efficient, and robust multi-sensor data fusion framework.

Point-of-care ultrasound for monitoring catheter tip location during umbilical vein catheterization in neonates: a prospective study

Background

Point-of-care ultrasound (POCUS) can guide umbilical vein catheter placement in real time and monitor catheter tip position, allowing avoidance of severe complications due to catheter malposition. This study aims to explore the effectiveness of POCUS in guiding venous catheter insertion and monitoring complications.

Methods

Sixty-eight neonates with ultrasound-guided venous catheter insertion at the Neonatal Department of Dongguan Children's Hospital between December 2020 and February 2022 were included. POCUS was applied to monitor catheter tip location daily until catheter removal. A displacement range exceeding the intersection of the inferior vena cava and right atrium by ±0.5 cm was considered misalignment.

Results

Sixty-four neonates had a displaced catheter tip (94.1%, 64/68), with a median displacement distance of 0.4 cm (minimum -0.2 cm, maximum 1.2 cm). Ten neonates had a misalignment (14.7%, 10/68) caused by displacement. Displacement usually occurs within 2-4 days after placement, with displacement rates of 94.1% (64/68), 90.6% (58/64), and 98.3% (59/60) on days 2, 3, and 4, respectively, and could still occur on day 9 post-placement. In addition, misalignment mainly occurs on the second day after placement. During the monitoring process, 58 neonates had catheter tip displacement ≥2 times, resulting in 252 displacement and 22 misalignment incidents. Among them, the catheter tip migrated outward from the inferior vena cava seven times, all of which were removed in time. Ultrasound was used for positioning 486 times, and x-ray was indirectly avoided 486 times.

Conclusion

The catheter tip is prone to displacement and misalignment after umbilical vein catheterization, which most commonly occurs on days 2-4. POCUS is recommended for daily monitoring of the tip location during umbilical vein catheterization until catheter removal.

Exploring native and non-native English speaker teachers' perceptions of English teacher qualities and their students' responses

Due to globalization, English has gradually become a lingua franca, leading to a rising demand for proficient English teachers all over the globe. In China, more EFL teachers are being recruited, particularly at the tertiary level, with a greater preference for so-called "native English speaking teachers (NESTs)" over "non-native English-speaking teachers (NNESTs)" due to the impacts of native-speakerism. Research has shown NESTs, NNESTs, and students are often misaligned in terms of beliefs about language learning and teaching which affect teaching effectiveness as well as student achievement. Recognizing this issue, this study investigated NESTs', NNESTs', and Chinese English-major students' perceptions of characteristics of effective EFL teachers at four mid-tier universities across China. Findings from semi-structured interviews with 16 students suggest that NNESTs and Chinese English-major students had similar views on language learning and teaching. Both groups valued prerequisite qualities such as having expert knowledge, language skills, teaching skills, and professionalism. NESTs, however, valued qualities such as caring, patience, flexibility, engagement, and awareness of students' learning needs. These differences are likely the result of these two groups of teachers' linguistic, cultural, and educational background differences. The highly uniform views of the two groups of teachers suggest that they tended to emphasize certain qualities while disregarding others. These findings suggest the need to raise teachers' and students' awareness of the benefits of different types of teacher qualities so that curriculum design and lesson planning can be implemented for better instructional alignment to ultimately improve teaching effectiveness.

DNN-Based Estimation for Misalignment State of Automotive Radar Sensor

The reliability and safety of advanced driver assistance systems and autonomous vehicles are highly dependent on the accuracy of automotive sensors such as radar, lidar, and camera. However, these sensors can be misaligned compared to the initial installation state due to external shocks, and it can cause deterioration of their performance. In the case of the radar sensor, when the mounting angle is distorted and the sensor tilt toward the ground or sky, the sensing performance deteriorates significantly. Therefore, to guarantee stable detection performance of the sensors and driver safety, a method for determining the misalignment of these sensors is required. In this paper, we propose a method for estimating the vertical tilt angle of the radar sensor using a deep neural network (DNN) classifier. Using the proposed method, the mounting state of the radar can be easily estimated without physically removing the bumper. First, to identify the characteristics of the received signal according to the radar misalignment states, radar data are obtained at various tilt angles and distances. Then, we extract range profiles from the received signals and design a DNN-based estimator using the profiles as input. The proposed angle estimator determines the tilt angle of the radar sensor regardless of the measured distance. The average estimation accuracy of the proposed DNN-based classifier is over 99.08%. Therefore, through the proposed method of indirectly determining the radar misalignment, maintenance of the vehicle radar sensor can be easily performed.

Preliminary evidence that misalignment between sleep and circadian timing alters risk-taking preferences

Decision-making has been shown to suffer when circadian preference is misaligned with time of assessment; however, little is known about how misalignment between sleep timing and the central circadian clock impacts decision-making. This study captured naturally occurring variation in circadian alignment (i.e., alignment of sleep-wake timing with the central circadian clock) to examine if greater misalignment predicts worse decision-making. Over the course of 2 weeks, 32 late adolescent drinkers (aged 18-22 years; 61% female; 69% White) continuously wore actigraphs and completed two overnight in-laboratory visits (Thursday and Sunday) in which both dim-light melatonin onset (DLMO) and behavioural decision-making (risk taking, framing, and strategic reasoning tasks) were assessed. Sleep-wake timing was assessed by actigraphic midsleep from the 2 nights prior to each in-laboratory visit. Alignment was operationalised as the phase angle (interval) between average DLMO and average midsleep. Multilevel modelling was used to predict performance on decision-making tasks from circadian alignment during each in-laboratory visit; non-linear associations were also examined. Shorter DLMO-midsleep phase angle predicted greater risk-taking under conditions of potential loss (B = -0.11, p = 0.06), but less risk-taking under conditions of potential reward (B = 0.14, p = 0.03) in a curvilinear fashion. Misalignment did not predict outcomes in the framing and strategic reasoning tasks. Findings suggest that shorter alignment in timing of sleep with the central circadian clock (e.g., phase-delayed misalignment) may impact risky decision-making, further extending accumulating evidence that sleep/circadian factors are tied to risk-taking. Future studies will need to replicate findings and experimentally probe whether manipulating alignment influences decision-making.

Chronic jetlag accelerates pancreatic neoplasia in conditional Kras-mutant mice

Misalignment of the circadian clock compared to environmental cues causes circadian desynchrony, which is pervasive in humans. Clock misalignment can lead to various pathologies including obesity and diabetes, both of which are associated with pancreatic ductal adenocarcinoma - a devastating cancer with an 80% five-year mortality rate. Although circadian desynchrony is associated with an increased risk of several solid-organ cancers, the correlation between clock misalignment and pancreas cancer is unclear. Using a chronic jetlag model, we investigated the impact of clock misalignment on pancreas cancer initiation in mice harboring a pancreas-specific activated Kras mutation. We found that chronic jetlag accelerated the development of pancreatic cancer precursor lesions, with a concomitant increase in precursor lesion grade. Cell-autonomous knock-out of the clock in pancreatic epithelial cells of Kras-mutant mice demonstrated no acceleration of precursor lesion formation, indicating non-cell-autonomous clock dysfunction was responsible for the expedited tumor development. Therefore, we applied single-cell RNA sequencing over time and identified fibroblasts as the cell population manifesting the greatest clock-dependent changes, with enrichment of specific cancer-associated fibroblast pathways due to circadian misalignment.

High-Efficiency Wireless-Power-Transfer System Using Fully Rollable Tx/Rx Coils and Metasurface Screen

This work presents a high-efficiency reconfigurable wireless-power-transfer (WPT) system using fully rollable Tx/Rx coils and a metasurface (MS) screen working at 6.78 MHz, for the first time. The MS screens are placed between the Tx and Rx to magnify the power-transfer efficiency (PTE) of the WPT system. The proposed MS-based WPT can be rolled down or rolled up as required, which allows end-users to use the space more flexibly. In the measurement results, the PTE of the WPT is improved from 13.32% to 32.49% at a power-transfer distance (PTD) of 40 cm with one MS screen, 5.42% to 42.25% at a PTD of 50 cm with two MS screens, 1.78% to 49% at a PTD of 60 cm with three MS screens, 0.85% to 46.24% at a PTD of 70 cm with four MS screens. The measured PTE results indicate that the demonstrated MS screens are greatly effective for magnifying the PTE and the PTD of the WPT. In addition, the measured PTE results in the misaligned condition verify that the MS screens also help increase the PTE of the WPT even in the misalignment condition.

Divergent remodeling of the skeletal muscle metabolome over 24 h between young, healthy men and older, metabolically compromised men

24 h whole-body substrate metabolism and the circadian clock within skeletal muscle are both compromised upon metabolic disease in humans. Here, we assessed the 24 h muscle metabolome by serial muscle sampling performed under 24 h real-life conditions in young, healthy (YH) men versus older, metabolically compromised (OMC) men. We find that metabolites associated with the initial steps of glycolysis and hexosamine biosynthesis are higher in OMC men around the clock, whereas metabolites associated with glutamine-alpha-ketoglutarate, ketone, and redox metabolism are lower in OMC men. The night period shows the largest number of differently expressed metabolites. Both groups demonstrate 24 h rhythmicity in half of the metabolome, but rhythmic metabolites only partially overlap. Specific metabolites are only rhythmic in YH men (adenosine), phase shifted in OMC men (cis-aconitate, flavin adenine dinucleotide [FAD], and uridine diphosphate [UDP]), or have a reduced 24 h amplitude in OMC men (hydroxybutyrate and hippuric acid). Our data highlight the plasticity of the skeletal muscle metabolome over 24 h and large divergence across the metabolic health spectrum.

Improving the magnet alignment of undulator systems by laser interferometer

The issue of intrinsic-type misalignment errors arising from angular offsets between magnets in an undulator is addressed. A random tilt of the magnets or poles generates undesirable magnetic field components in both transverse and longitudinal directions and gives rise to errors in period lengths and amplitudes. These localized errors are carried to the entire undulator segments and are a cause of concern for precision field integral and phase error estimates. A laser interferometer has been designed to read the offsets and to fix the magnets to minimize the offsets.

No Effect of Chronotype on Hunger or Snack Consumption during a Night Shift with Acute Sleep Deprivation

Night shift workers experience circadian misalignment and sleep disruption, which impact hunger and food consumption. The study aim was to assess the impact of chronotype on hunger and snack consumption during a night shift with acute sleep deprivation. Seventy-two (36f, 36m) healthy adults participated in a laboratory study. A sleep opportunity (03:00-12:00) was followed by a wake period (12:00-23:00) and a simulated night shift (23:00-07:00). Subjective measures of hunger, prospective consumption, desire to eat fruit, and desire to eat fast food were collected before (12:20, 21:50) and after (07:20) the night shift. Snack opportunities were provided before (15:10, 19:40) and during (23:50, 03:30) the night shift. A tertile split of the dim light melatonin onset (DLMO) distribution defined early (20:24 ± 0:42 h), intermediate (21:31 ± 0:12 h), and late chronotype (22:56 ± 0:54 h) categories. There were no main effects of chronotype on any subjective measure (p = 0.172-0.975), or on snack consumption (p = 0.420), and no interactions between chronotype and time of day on any subjective measure (p = 0.325-0.927) or on snack consumption (p = 0.511). Differences in circadian timing between chronotype categories were not associated with corresponding differences in hunger, prospective consumption, desire to eat fruit, desire to eat fast food, or snack consumption at any measurement timepoint.

Tilt Sensor with Recalibration Feature Based on MEMS Accelerometer

The main errors of MEMS accelerometers are misalignments of their sensitivity axes, thermal and long-term drifts, imprecise factory calibration, and aging phenomena. In order to reduce these errors, a two-axial tilt sensor comprising a triaxial MEMS accelerometer, an aligning unit, and solid cubic housing was built. By means of the aligning unit it was possible to align the orientation of the accelerometer sensitive axes with respect to the housing with an accuracy of 0.03°. Owing to the housing, the sensor could be easily and quickly recalibrated, and thus errors such as thermal and long-term drifts as well as effects of aging were eliminated. Moreover, errors due to local and temporal variations of the gravitational acceleration can be compensated for. Procedures for calibrating and aligning the accelerometer are described. Values of thermal and long-term drifts of the tested sensor, resulting in tilt errors of even 0.4°, are presented. Application of the sensor for monitoring elevated loads is discussed.

Design and Optimization of Ultrasonic Links With Phased Arrays for Wireless Power Transmission to Biomedical Implants

Ultrasound (US) is an attractive modality for wireless power transfer (WPT) to biomedical implants with millimeter (mm) dimensions. To compensate for misalignments in WPT to a mm-sized implant (or powering a network of mm-sized implants), a US transducer array should electronically be driven in a beamforming fashion (known as US phased array) to steer focused US beams at different locations. This paper presents the theory and design methodology of US WPT links with phased arrays and mm-sized receivers (Rx). For given constraints imposed by the application and fabrication, such as load (R_L) and focal distance (F), the optimal geometries of a US phased array and Rx transducer, as well as the optimal operation frequency (f_c) are found through an iterative design procedure to maximize the power transfer efficiency (PTE). An optimal figure of merit (FoM) related to PTE is proposed to simplify the US array design. A design example of a US link is presented and optimized for WPT to a mm-sized Rx with a linear array. In measurements, the fabricated 16-element array (10.9×9×1.7 mm³) driven by 100 V pulses at f_c of 1.1 MHz with optimal delays for focusing at F = 20 mm generated a US beam with a pressure output of 0.8 MPa. The link could deliver up to 6 mW to a ∼ 1 mm³ Rx with a PTE of 0.14% (R_L = 850 Ω). The beam steering capability of the array at -45^o to 45^o angles was also characterized.

Cell-Type-Specific Circadian Bioluminescence Rhythms in Dbp Reporter Mice

Circadian rhythms are endogenously generated physiological and molecular rhythms with a cycle length of about 24 h. Bioluminescent reporters have been exceptionally useful for studying circadian rhythms in numerous species. Here, we report development of a reporter mouse generated by modification of a widely expressed and highly rhythmic gene encoding D-site albumin promoter binding protein (Dbp). In this line of mice, firefly luciferase is expressed from the Dbp locus in a Cre recombinase-dependent manner, allowing assessment of bioluminescence rhythms in specific cellular populations. A mouse line in which luciferase expression was Cre-independent was also generated. The Dbp reporter alleles do not alter Dbp gene expression rhythms in liver or circadian locomotor activity rhythms. In vivo and ex vivo studies show the utility of the reporter alleles for monitoring rhythmicity. Our studies reveal cell-type-specific characteristics of rhythms among neuronal populations within the suprachiasmatic nuclei ex vivo. In vivo studies show Dbp-driven bioluminescence rhythms in the liver of Albumin-Cre;Dbp^KI/+ "liver reporter" mice. After a shift of the lighting schedule, locomotor activity achieved the proper phase relationship with the new lighting cycle more rapidly than hepatic bioluminescence did. As previously shown, restricting food access to the daytime altered the phase of hepatic rhythmicity. Our model allowed assessment of the rate of recovery from misalignment once animals were provided with food ad libitum. These studies confirm the previously demonstrated circadian misalignment following environmental perturbations and reveal the utility of this model for minimally invasive, longitudinal monitoring of rhythmicity from specific mouse tissues.

Is the Way Forward to Step Back? Documenting the Frequency with which Study Goals are Misaligned with Study Methods and Interpretations in the Epidemiologic Literature

In any research study, there is an underlying research process that should begin with a clear articulation of the study's goal. The study's goal drives this process; it determines many study features including the estimand of interest, the analytic approaches that can be used to estimate it, and which coefficients, if any, should be interpreted. "Misalignment" can occur in this process when analytic approaches and/or interpretations do not match the study's goal; misalignment is potentially more likely to arise when study goals are ambiguously framed. This study documented misalignment in the observational epidemiologic literature and explored how the framing of study goals contributes to its occurrence. The following misalignments were examined: 1) use of an inappropriate variable selection approach for the goal (a "goal-methods" misalignment) and 2) interpretation of coefficients of variables for which causal considerations were not made (e.g., Table 2 Fallacy, a "goal-interpretation" misalignment). A random sample of 100 articles published 2014-2018 in the top 5 general epidemiology journals were reviewed. Most reviewed studies were causal, with either explicitly stated (13/103, 13%) or associationally-framed (71/103, 69%) aims. Full alignment of goal-methods-interpretations was infrequent (9/103, 9%), although clearly causal studies (5/13, 38%) were more often fully aligned than seemingly causal ones (3/71, 4%). Goal-methods misalignments were common (34/103, 33%), but most frequently, methods were insufficiently reported to draw conclusions (47/103, 46%). Goal-interpretations misalignments occurred in 31% (32/103) of studies and occurred less often when the methods were aligned (2/103, 2%) compared with when the methods were misaligned (13/103, 13%).

Tolerance to geometrical inaccuracies in CBCT systems: A comprehensive study

PURPOSE

The last decades have seen the consolidation of the cone-beam CT (CBCT) technology, which is nowadays widely used for different applications such as micro-CT for small animals, mammography, dentistry, or surgical procedures. Some CBCT systems may suffer mechanical strains due to the heavy load of the x-ray tube. This fact, together with tolerances in the manufacturing process, lead to different types of undesirable effects in the reconstructed image unless they are properly accounted for during the reconstruction. To obtain good quality images, it is necessary to have a complete characterization of the system geometry including the angular position of the gantry, the source-object and detector-object distances, and the position and pose of the detector. These parameters can be obtained through a calibration process done periodically, depending on the stability of the system geometry. To the best of our knowledge, there are no comprehensive works studying the effect of inaccuracies in the geometrical calibration of CBCT systems in a systematic and quantitative way. In this work, we describe the effects of detector misalignments (linear shifts, rotation, and inclinations) on the image and define their tolerance as the maximum error that keeps the image free from artifacts.

METHODS

We used simulations of four phantoms including systematic and random misalignments. Reconstructions of these data with and without errors were compared to identify the artifacts introduced in the reconstructed image and the tolerance to miscalibration deemed to provide acceptable image quality.

RESULTS

Visual assessment provided an easy guideline to identify the sources of error by visual inspection of the artifactual images. Systematic errors result in blurring, shape distortion and/or reduction of the axial field of view while random errors produce streaks and blurring in all cases, with a tolerance which is more than twice that of systematic errors. The tolerance corresponding to errors in position of the detector along the tangential direction, that is, skew (<0.2°) and horizontal shift (<0.4 mm), is tighter than the tolerance to those errors affecting the position along the longitudinal direction or the magnification, that is, vertical shift (<2 mm), roll (<1.5°), tilt (<2°), and SDD (<3 mm).

CONCLUSION

We present a comprehensive study, based on realistic simulations, of the effects on the reconstructed image quality of errors in the geometrical characterization of a CBCT system and define their tolerance. These results could be used to guide the design of new systems, establishing the mechanical precision that must be achieved, and to help in the definition of an optimal geometrical calibration process. Also, the thorough visual assessment may be valuable to identify the most predominant sources of error based on the effects shown in the reconstructed image.

Misalignment Fault Prediction of Wind Turbines Based on Improved Artificial Fish Swarm Algorithm

A misalignment fault is a kind of potential fault in double-fed wind turbines. The reasonable and effective fault prediction models are used to predict its development trend before serious faults occur, which can take measures to repair in advance and reduce human and material losses. In this paper, the Least Squares Support Vector Machine optimized by the Improved Artificial Fish Swarm Algorithm is used to predict the misalignment index of the experiment platform. The mixed features of time domain, frequency domain, and time-frequency domain indexes of vibration or stator current signals are the inputs of the Least Squares Support Vector Machine. The kurtosis of the same signals is the output of the model, and the 3σ principle of the normal distribution is adopted to set the warning line of misalignment fault. Compared with other optimization algorithms, the experimental results show that the proposed prediction model can predict the development trend of the misalignment index with the least prediction error.

Multi-scale semi-analytical model for fatigue life prediction of trans-tibial prosthetic sockets

The trans-tibial socket is an essential component of the prosthesis that connects it to the residual limb. Socket misalignments and permanent deformations reduce the comfort of the amputee. In order to forestall such issues, sufficient information about the socket lifespan needs to be acquired, which is fairly difficult given the lack of calculation methods that estimate the fatigue life in the literature. In this paper a semi-analytical model is proposed based on experimental results. It highlights the effects of the amputee average daily walking time on the socket fatigue life. A proportionality relationship is demonstrated linking the Burgers model parameters at the structural scale to those at the macroscopic scale. Hence, it becomes possible to evaluate the permanent deformation that induces a misalignment in the socket. These results are useful for the designers to predict the fatigue life of the socket, and also for clinicians to monitor the mechanical degradation of the trans-tibial socket and schedule maintenance or replacement.

Misalignment Fault Diagnosis for Wind Turbines Based on Information Fusion

Most conventional wind turbine fault diagnosis techniques only use a single type of signal as fault feature and their performance could be limited to such signal characteristics. In this paper, multiple types of signals including vibration, temperature, and stator current are used simultaneously for wind turbine misalignment diagnosis. The model is constructed by integrated methods based on Dempster-Shafer (D-S) evidence theory. First, the time domain, frequency domain, and time-frequency domain features of the collected vibration, temperature, and stator current signal are respectively taken as the inputs of the least square support vector machine (LSSVM). Then, the LSSVM outputs the posterior probabilities of the normal, parallel misalignment, angular misalignment, and integrated misalignment of the transmission systems. The posterior probabilities are used as the basic probabilities of the evidence fusion, and the fault diagnosis is completed according to the D-S synthesis and decision rules. Considering the correlation between the inputs, the vibration and current feature vectors' dimensionalities are reduced by t-distributed stochastic neighbor embedding (t-SNE), and the improved artificial bee colony algorithm is used to optimize the parameters of the LSSVM. The results of the simulation and experimental platform demonstrate the accuracy of the proposed model and its superiority compared with other models.

Gender-specific difference of in-vivo kinematics in patients with unilateral total hip arthroplasty

PURPOSE

Asymmetric gait patterns are known to persist in patients with unilateral total hip arthroplasty (THA). Little is known about the effect of gender on gait asymmetry. This study aimed to determine whether gait asymmetry differs between genders in unilateral THA patients and can be explained by component positioning.

METHODS

23 female and 10 male unilateral THA patients were included. Asymmetric hip kinematics during gait and component positioning were quantified using a combined computed tomography-based modelling and dual fluoroscopic imaging system. Multiple regression was performed to examine the unique and mediated contribution of gender to observed gait asymmetry.

RESULTS

Female and male patients differed most significantly in frontal plane gait asymmetry (p = 0.001) and bilateral difference of vertical femoral offset (p = 0.048). Compared with the native hip, the implanted hip exhibited significantly increased adduction (p = 0.007) in females but significantly increased abduction (p = 0.001) in males. The stem head of the implanted hip was more superiorly positioned compared to the native femoral head in female but more inferiorly positioned in male. Gender accounted for 41.5% variance of frontal plane gait asymmetry and was partially mediated by the bilateral difference of vertical femoral offset.

CONCLUSIONS

Female unilateral THA patients exhibited significantly increased adduction in the implanted hip compared to the native hip, which is partially attributable to a more superiorly positioned femoral stem centre of rotation. The understanding of gender-specific differences of kinematic patterns may benefit female patients through targeted preoperative planning and postoperative rehabilitation.

Association Between Mobile Phone Radiation Exposure and the Secretion of Melatonin and Cortisol, Two Markers of the Circadian System: A Review

The extremely important use of mobile phones in the world, at all ages of life, including children and adolescents, leads to significant exposure of these populations to electromagnetic waves of radiofrequency. The question, therefore, arises as to whether exposure to these radiofrequencies (RFs) could lead to deleterious effects on the body's biological systems and health. In the current article, we review the effects, in laboratory animals and humans, of exposure to RF on two hormones considered as endocrine markers: melatonin, a neurohormone produced by the pineal gland and cortisol, a glucocorticosteroid synthesized by the adrenal glands. These two hormones are also considered as markers of the circadian system. The literature search was performed using PubMed, Medline, Web of Sciences (ISI Web of Knowledge), Google Scholar, and EMF Portal. From this review on RF effects on cortisol and melatonin, it appears that scientific papers in the literature are conflicting, showing effects, no effects, or inconclusive data. This implies the need for additional research on higher numbers of subjects and with protocols perfectly controlled with follow-up studies to better determine whether the chronic effect of RF on the biological functioning and health of users exists (or not). Bioelectromagnetics. 2021;42:5-17. © 2020 Bioelectromagnetics Society.

Development of the Correction Algorithm to Limit the Deformation of Bacterial Colonies Diffraction Patterns Caused by Misalignment and Its Impact on the Bacteria Identification in the Proposed Optical Biosensor

Recently proposed methods of bacteria identification in optical biosensors based on the phenomenon of light diffraction on macro-colonies offer over 98% classification accuracy. However, such high accuracy relies on the comparable and repeatable spatial intensity distribution of diffraction patterns. Therefore, it is essential to eliminate all non-species/strain-dependent factors affecting the diffraction patterns. In this study, the impact of the bacterial colony and illuminating beam misalignment on the variation of classification features extracted from diffraction patterns was examined. It was demonstrated that misalignment introduced by the scanning module significantly affected diffraction patterns and extracted classification features used for bacteria identification. Therefore, it is a crucial system-dependent factor limiting the identification accuracy. The acceptable misalignment level, when the accuracy and quality of the classification features are not affected, was determined as no greater than 50 µm. Obtained results led to development of image-processing algorithms for determination of the direction of misalignment and concurrent alignment of the bacterial colonies’ diffraction patterns. The proposed algorithms enable the rigorous monitoring and controlling of the measurement’s conditions in order to preserve the high accuracy of bacteria identification.

Pilot Observational Study to Detect Diurnal Variation and Misalignment in Heart Rate Among Critically Ill Patients

Circadian disruption is common in critically ill patients admitted to the intensive care unit (ICU). Understanding and treating circadian disruption in critical illness has significant potential to improve critical illness outcomes through improved cognitive, immune, cardiovascular, and metabolic function. Measurement of circadian alignment (i.e., circadian phase) can be resource-intensive as it requires frequent blood or urine sampling over 24 or more hours. Less cumbersome methods of assessing circadian alignment would advance investigations in this field. Thus, the objective of this study is to examine the feasibility of using continuous telemetry to assess diurnal variation in heart rate (HR) among medical ICU patients as a proxy for circadian alignment. In exploratory analyses, we tested for associations between misalignment of diurnal variation in HR and death during hospital admission. This was a prospective observational cohort study embedded within a prospective medical ICU biorepository. HR data were continuously collected (every 5 s) via telemetry systems for the duration of the medical ICU admission; the first 24 h of this data was analyzed. Patients were extensively characterized via medical record chart abstraction and patient interviews. Of the 56 patients with complete HR data, 48 (86%) had a detectable diurnal variation. Of these patients with diurnal variation, 39 (81%) were characterized as having the nadir of their HR outside of the normal range of 02:00–06:00 (“misalignment”). Interestingly, no deaths occurred in the patients with normally aligned diurnal variation; in contrast, there were seven deaths (out of 39 patients) in patients who had misaligned diurnal variation in HR. In an exploratory analysis, we found that the odds ratio of death for misaligned vs. aligned patients was increased at 4.38; however, this difference was not statistically significant (95% confidence interval 0.20–97.63). We conclude that diurnal variation in HR can be detected via continuous telemetric monitoring of critically ill patients. A majority of these patients with diurnal variation exhibited misalignment in their first 24 h of medical ICU admission. Exploratory analyses suggest possible associations between misalignment and death.

ALK Inhibitors-Induced M Phase Delay Contributes to the Suppression of Cell Proliferation

Anaplastic lymphoma kinase (ALK), a receptor-type tyrosine kinase, is involved in the pathogenesis of several cancers. ALK has been targeted with small molecule inhibitors for the treatment of different cancers, but absolute success remains elusive. In the present study, the effects of ALK inhibitors on M phase progression were evaluated. Crizotinib, ceritinib, and TAE684 suppressed proliferation of neuroblastoma SH-SY5Y cells in a concentration-dependent manner. At approximate IC₅₀ concentrations, these inhibitors caused misorientation of spindles, misalignment of chromosomes and reduction in autophosphorylation. Similarly, knockdown of ALK caused M phase delay, which was rescued by re-expression of ALK. Time-lapse imaging revealed that anaphase onset was delayed. The monopolar spindle 1 (MPS1) inhibitor, AZ3146, and MAD2 knockdown led to a release from inhibitor-induced M phase delay, suggesting that spindle assembly checkpoint may be activated in ALK-inhibited cells. H2228 human lung carcinoma cells that express EML4-ALK fusion showed M phase delay in the presence of TAE684 at about IC₅₀ concentrations. These results suggest that ALK plays a role in M phase regulation and ALK inhibition may contribute to the suppression of cell proliferation in ALK-expressing cancer cells.

Evaluation of the Influence of Head Movement on Hearing Aid Algorithm Performance Using Acoustic Simulations

Head movements can improve sound localization performance and speech intelligibility in acoustic environments with spatially distributed sources. However, they can affect the performance of hearing aid algorithms, when adaptive algorithms have to adjust to changes in the acoustic scene caused by head movement (the so-called maladaptation effect) or when directional algorithms are not facing in the optimal direction because the head has moved away (the so-called misalignment effect). In this article, we investigated the mechanisms behind these maladaptation and misalignment effects for a set of six standard hearing aid algorithms using acoustic simulations based on premade databases; this was done so we could study the effects as carefully as possible. Experiment 1 investigated the maladaptation effect by analyzing hearing aid benefit after simulated rotational head movement in simple anechoic noise scenarios. The effects of movement parameters (start angle and peak velocity), noise scenario complexity, and adaptation time were studied, as well as the recovery time of the algorithms. However, a significant maladaptation effect was only found in the most unrealistic anechoic scenario with one noise source. Experiment 2 investigated the effects of maladaptation and misalignment using previously recorded natural head movements in acoustic scenes resembling everyday life situations. In line with the results of Experiment 1, no effect of maladaptation was found in these more realistic acoustic scenes. However, a significant effect of misalignment on the performance of directional algorithms was found. This demonstrates the need to take head movement into account in the evaluation of directional hearing aid algorithms.

The effect of knee brace misalignment on the anterior cruciate ligament: An experimental study

BACKGROUND

Protective knee braces are used for rehabilitation or prevention. Due to poor patient compliance or slippage, the brace might be misaligned with the knee axis.

OBJECTIVES

Does a misaligned knee brace stress the anterior cruciate ligament?

STUDY DESIGN

It is an experimental study.

METHODS

A strain sensor was implanted on the anterior cruciate ligament in eight limbs. The limbs were mounted in a knee simulator, muscle forces were applied and a cyclic motion from 10° to 60° flexion was performed under three conditions: unbraced, braced and with a misaligned brace.

OUTCOME MEASURES

The outcome measures were anterior cruciate ligament strain and three-dimensional kinematics of the knee joint.

RESULTS

The correctly aligned brace significantly reduced the anterior cruciate ligament strain at 10° compared to the unbraced condition from 0% to -1.54% (standard deviation = 1.4). The misaligned brace neutralised the effect of bracing to -0.06% (standard deviation = 1.1) anterior cruciate ligament strain. At 60° flexion angle, bracing had no statistically significant effect on the anterior cruciate ligament strain compared to the unbraced knee: -2.58% (standard deviation = 0.8) versus -1.64% (standard deviation = 1.0). The anterior cruciate ligament in the misaligned braced knee at 60° flexion with a strain of -1.1% (standard deviation = 0.9) was significantly more stressed than in the correctly aligned condition. An effect of bracing on knee kinematics was not detected.

CONCLUSION

A correctly aligned knee brace reduced anterior cruciate ligament strain. By contrast, a misaligned brace tended to increase the anterior cruciate ligament strain compared to the unbraced knee.

CLINICAL RELEVANCE

The correct alignment of the brace was identified as a key factor decisively influencing the effectiveness of bracing.

Effect of cylinder power and axis changes on vision in astigmatic participants

PURPOSE

To ascertain the impact of altering cylinder (cyl) power and axis on vision in astigmatism.

METHODS

In a prospective, randomized, participant-masked, crossover clinical trial, 28 astigmatic participants were tested for the following conditions on different days: full sphero-cyl correction and undercorrection by 0.25, 0.50, and 0.75 DC while maintaining spherical equivalence. Axis was also misaligned between -30° and +30°, in 10° steps. For each configuration, monocular high- and low-contrast visual acuities (HCVA, LCVA) were measured at 6 m, and participants rated vision clarity (1-10), vision satisfaction (1-10), and vision acceptability (yes/no). Linear mixed models were used to compare visual performance in the overall group and in low, medium, and high cyl subgroups.

RESULTS

Undercorrecting cyl power affected all groups equally (P≥0.073). Undercorrection by 0.75 DC was significantly different to full cyl power for all variables (P≤0.007), while 0.25 DC undercorrection did not cause any significant decreases (P>0.05). Undercorrection by 0.50 DC was significantly different to full cyl power for HCVA (P=0.006, however not clinically significant) and vision acceptability (P=0.034). Axis misalignment affected the cyl groups differently (P<0.001), with the greatest impact in the high cyl group, followed by the medium then the low-cyl group. Misalignment by ±30° caused significant decreases in almost all cases (P≤0.003), while misalignments by ±10° or ±20° caused significant decreases for some cyl groups and test variables.

CONCLUSION

Undercorrection of cyl by ≤0.50 DC while maintaining spherical equivalence has no significant effect on HCVA, LCVA, vision clarity, and vision satisfaction, while the amount of axis misalignment that can be tolerated is dependent on the cyl power. These results may have practical ophthalmic applications, such as reducing the total number of stock keeping units of toric contact lenses.

Comparison of incidence of repositioning surgery to correct misalignment with three toric intraocular lenses

PURPOSE

To compare the incidence of re-orientating surgery to improve misalignment of three models of acrylic toric intraocular lenses: AcrySof toric intraocular lens (Alcon Laboratories, Inc.), TECNIS toric intraocular lens (Johnson & Johnson Vision, Inc.) and HOYA 355 toric intraocular lens (HOYA).

METHODS

In this retrospective, multicenter case series, medical charts were reviewed for collecting data on realignment surgery of toric intraocular lenses at 10 ophthalmic surgical sites in Japan.

RESULTS

Over all, intraocular lens repositioning surgery was conducted in 89 of 9430 eyes (0.944%) at an average of 10.5 ± 9.7 days after the initial cataract surgery. The incidence was 0.213% (11/5155), 1.797% (62/3451) and 1.942% (16/824) with AcrySof, TECNIS and HOYA toric intraocular lenses, respectively. The incidence was significantly lower with AcrySof than with other two brands of toric intraocular lenses (p < 0.0001). In those eyes which underwent reorientation surgery, the amount of misalignment was 26.4 ± 21.9°, 29.7 ± 15.4° and 28.1 ± 20.7° with AcrySof, TECNIS and HOYA toric intraocular lenses, respectively; there was no significant difference among groups (p = 0.821). The repositioning surgery significantly reduced misalignment in all three groups.

CONCLUSION

The rotational stability was considerably different among toric intraocular lenses of different manufacturers. The incidence of repositioning surgery was significantly lower with AcrySof than with TECNIS and HOYA toric intraocular lenses.

Immediate Feedback Improves Career Decision Self-Efficacy and Aspirational Alignment

Misalignment between career and education aspirations has been associated with poorer achievement during adolescence and unstable employment in adulthood. In this study, we evaluated whether a brief in-school intervention improved career decision self-efficacy and aspirational alignment. We sampled 211 teenagers living in disadvantaged areas of Western Sydney, Australia using a quasi-experimental non-equivalent groups design. Students completed pre- and post-questionnaires which measured aspirational alignment and career decision self-efficacy. Students in the intervention condition (n = 102) received automated feedback on the alignment of their career and education aspirations, as well as a career information pamphlet detailing the educational pathways to a range of popular careers. Students in the control condition completed both questionnaires but only received feedback and the pamphlet at the end of the study. The intervention improved alignment of career and education aspirations, as well as increased some dimensions of career decision self-efficacy. Students in the intervention group more frequently identified the correct qualification for their career aspiration in the post-questionnaire (57.9%) compared with the pre-questionnaire (48.1%). Students with misaligned aspirations in the intervention group reported higher self-efficacy for gathering occupational information and selecting goals following the intervention. There were no pre-post differences for students in the control condition. The practical significance of this study is that an easy, low-cost intervention can improve aspirational alignment between career and education aspirations, as well as aspects of career decision self-efficacy.

Inhibitors of the VEGF Receptor Suppress HeLa S3 Cell Proliferation via Misalignment of Chromosomes and Rotation of the Mitotic Spindle, Causing a Delay in M-Phase Progression

Cell division is the process by which replicated chromosomes are separated into two daughter cells. Although regulation of M phase has been extensively investigated, not all regulating factors have been identified. Over the course of our research, small molecules were screened to identify those that regulate M phase. In the present study, the vascular endothelial growth factor receptor (VEGFR) inhibitors A83-01, SU4312, and Ki8751 were examined to determine their effects on M phase. Treatment of HeLa S3 cells with these inhibitors suppressed cell proliferation in a concentration-dependent manner, and also suppressed Akt phosphorylation at Ser473, a marker of Akt activation. Interestingly, cleaved caspase-3 was detected in Adriamycin-treated cells but not in inhibitor-treated cells, suggesting that these inhibitors do not suppress cell proliferation by causing apoptosis. A cell cycle synchronization experiment showed that these inhibitors delayed M phase progression, whereas immunofluorescence staining and time-lapse imaging revealed that the M phase delay was accompanied by misalignment of chromosomes and rotation of the mitotic spindle. Treatment with the Mps1 inhibitor AZ3146 prevented the SU4312-induced M phase delay. In conclusion, the VEGFR inhibitors investigated here suppress cell proliferation by spindle assembly checkpoint-induced M phase delay, via misalignment of chromosomes and rotation of the mitotic spindle.

An Improved Pansharpening Method for Misaligned Panchromatic and Multispectral Data

Numerous pansharpening methods were proposed in recent decades for fusing low-spatial-resolution multispectral (MS) images with high-spatial-resolution (HSR) panchromatic (PAN) bands to produce fused HSR MS images, which are widely used in various remote sensing tasks. The effect of misregistration between MS and PAN bands on quality of fused products has gained much attention in recent years. An improved method for misaligned MS and PAN imagery is proposed, through two improvements made on a previously published method named RMI (reduce misalignment impact). The performance of the proposed method was assessed by comparing with some outstanding fusion methods, such as adaptive Gram-Schmidt and generalized Laplacian pyramid. Experimental results show that the improved version can reduce spectral distortions of fused dark pixels and sharpen boundaries between different image objects, as well as obtain similar quality indexes with the original RMI method. In addition, the proposed method was evaluated with respect to its sensitivity to misalignments between MS and PAN bands. It is certified that the proposed method is more robust to misalignments between MS and PAN bands than the other methods.

Association between depressive symptoms and morningness-eveningness, sleep duration and rotating shift work in Japanese nurses

Higher depressive symptoms have been reported in rotating shift workers compared with day workers. Depressive symptoms in adults who do not engage in night work have also been shown to be associated with chronotype and sleep duration. This study examines associations between depressive symptoms, morningness-eveningness (i.e. the degree to which people prefer to be active in the morning or the evening), sleep duration and rotating shift work. Japanese nurses (1252 day workers and 1780 rotating shift workers, aged 20-59) were studied using a self-administered questionnaire. The questionnaire covered depressive symptoms, morningness-eveningness, sleep habits and demographic characteristics of the participants. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to determine the levels of depressive symptoms. A Japanese version of the Morningness-Eveningness Questionnaire (MEQ) was used to measure morningness-eveningness. The CES-D score of shift workers was significantly (p < 0.05) higher than that of day workers. The MEQ score was significantly (p < 0.05) lower (i.e. greater eveningness) in shift workers than in day workers. Sleep duration on the day shift was significantly (p < 0.05) shorter in shift workers than in day workers. Simple linear regression revealed that the MEQ score, sleep duration on the day shift and current work shift (i.e. rotating shift work) were significantly (p < 0.05) associated with the CES-D score. Multivariate linear regression indicated that greater eveningness and shorter sleep duration were independently associated with higher CES-D scores, while rotating shift work was not. These associations between the MEQ score, the sleep duration and the CES-D score were also confirmed in both day workers and shift workers when the groups were analyzed separately. These results suggest that greater eveningness and shorter sleep duration on the day shift were independently associated with higher levels of depressive symptoms, which may explain associations between rotating shift workers and depressive symptoms. These findings have important implications for the development of novel strategies for preventing poor mental health in day workers and rotating shift workers.

Circadian Rhythms, Metabolism, and Chrononutrition in Rodents and Humans

Chrononutrition is an emerging discipline that builds on the intimate relation between endogenous circadian (24-h) rhythms and metabolism. Circadian regulation of metabolic function can be observed from the level of intracellular biochemistry to whole-organism physiology and even postprandial responses. Recent work has elucidated the metabolic roles of circadian clocks in key metabolic tissues, including liver, pancreas, white adipose, and skeletal muscle. For example, tissue-specific clock disruption in a single peripheral organ can cause obesity or disruption of whole-organism glucose homeostasis. This review explains mechanistic insights gained from transgenic animal studies and how these data are being translated into the study of human genetics and physiology. The principles of chrononutrition have already been demonstrated to improve human weight loss and are likely to benefit the health of individuals with metabolic disease, as well as of the general population.

Helvacioglu reproducibility index: a new algorithm to evaluate the effects of misalignments on the measurements of retinal nerve fiber layer by spectral-domain OCT

AIM

To evaluate the effect of misalignment on the measurements of retinal nerve fiber layer (RNFL) by spectral-domain optical coherence tomography (OCT).

METHODS

A total of 42 eyes from 21 healthy young subjects underwent RNFL measurements with RTVue spectral-domain OCT (Optovue Inc., Fremont, California, USA). Two baseline measurements with perfectly aligned central circle to the borders of the optic nerve and four misaligned measurements which were misaligned towards to four quadrants were taken. The differences in RNFL between the baseline and misaligned measurements were analyzed with a new algorithm called Helvacioglu reproducibility index (HRI) which is designed to measure the reproducibility of the scans by evaluating the RNFL changes in the four main quadrants.

RESULTS

The average RNFL scores of the first two baseline measurements have good correlation (c=0.930) and good reproducibility scores (0.15±0.07). Superior misaligned measurements had significantly lower superior quadrant score and higher inferior quadrant score, similar nasal and little higher temporal scores (P1, P2<0.001, P3=0.553, P4=0.001). Inferior misaligned measurements had significantly higher superior quadrant score and lower inferior quadrant score with similar temporal and little lower nasal scores (P1, P2<0.001, P3=0.315, P4=0.016). Nasal misaligned measurements had significantly higher temporal quadrant score and lower nasal quadrant score with little lower superior and inferior scores (P1, P2, P4<0.001, P3=0.005). Temporal misaligned measurements had significantly higher nasal quadrant score and lower temporal quadrant score with similar superior and little higher inferior scores (P1, P2<0.001, P3=0.943, P4=0.001).

CONCLUSION

Good alignment of the central circle to the borders of optic nerve is crucial to have correct and repeatable RNFL measurements. Misalignment to a quadrant resulted in falsely low readings at that quadrant and falsely high readings at the opposite quadrant.

Geometric Parameters Estimation and Calibration in Cone-Beam Micro-CT

The quality of Computed Tomography (CT) images crucially depends on the precise knowledge of the scanner geometry. Therefore, it is necessary to estimate and calibrate the misalignments before image acquisition. In this paper, a Two-Piece-Ball (TPB) phantom is used to estimate a set of parameters that describe the geometry of a cone-beam CT system. Only multiple projections of the TPB phantom at one position are required, which can avoid the rotation errors when acquiring multi-angle projections. Also, a corresponding algorithm is derived. The performance of the method is evaluated through simulation and experimental data. The results demonstrated that the proposed method is valid and easy to implement. Furthermore, the experimental results from the Micro-CT system demonstrate the ability to reduce artifacts and improve image quality through geometric parameter calibration.

The sensitivity of standard radiographic foot measures to misalignment

BACKGROUND

The purpose of this study was to identify the effects that X-ray source misalignment has on common measurements made from anterior-poster (AP) and medial-lateral (ML) view foot radiographs.

METHODS

A cadaveric foot model was used to obtain ML radiographs with ±25 degree transverse plane misalignment. From these images the calcaneal pitch angle (CPA) and lateral talometatarsal angle (LTMA) were measured. AP images were captured with up to 30 degree sagittal plane misalignment as well as ±15 degree misalignment in the transverse plane at each sagittal angle. From these images the talonavicular coverage angle (TNCA) and talometatarsal angle (TMA) were measured.

RESULTS

On the ML images, the CPA was sensitive to transverse plane misalignment from -10 to -25 degrees and from 15 to 25 degrees (P < .005). The LTMA was a more reliable measurement than the CPA and did not demonstrate sensitivity to transverse plane misalignment. On the AP images, the TNCA and TMA were not sensitive to sagittal plane misalignment alone. However, at 0, 10, and 15 degrees sagittal misalignment the TNCA showed sensitivity to transverse plane misalignment (P < .0083).

CONCLUSION

Misalignment of an X-ray source can lead to errors in the measurement of foot radiographic parameters, especially the CPA when there is transverse plane misalignment and the TNCA when there is both sagittal and transverse plane misalignment. The LTMA and TMA can be measured reliably, even with significant misalignment present.

CLINICAL RELEVANCE

If a researcher or clinician is interested in measuring the CPA or TNCA, the current best practices guidelines for obtaining ML and AP images should be closely followed.

Evaluation of actual retinal images produced by misaligned aspheric intraocular lenses in a model eye

Purpose

To examine the effect of misalignment (decentration and tilt) of intraocular lenses (IOLs) on retinal image quality using a water-immersed model eye with corneal spherical aberration adjusted to the values found in normal human eyes (spherical aberration 0.25 μm; pupil diameter 6 mm).

Methods

Three types of IOL holders were prepared. The first was without decentration or tilt, the second had a decentration of 0.5 mm, and the third had a tilt of 5.0°. One spherical IOL and three aspherical IOLs, each with a power of +20 D, were set in the holders and their optical properties (wave front aberration, defocused modulation transfer function, defocused point spread function, and Landolt ring simulations) were compared.

Results

Coma aberrations generated by misaligned IOLs were related to the spherical aberration corrective power of the IOLs. Landolt ring simulations show that the depth of focus increased as spherical aberration increased and that the retinal image quality was degraded by increases in coma aberration.

Conclusion

Coma aberration was generated by IOLs with a large degree of spherical aberration correction, leading to reduced retinal image quality when the IOL was misaligned. This suggests that, in a clinical setting, the quality of vision might be improved by reducing the degree of coma aberration using IOLs that retain, or minimally correct, spherical aberration.

Complications after revision surgery of malreduced ankle fractures

Ankle fractures are common orthopedic injuries requiring reduction and cast immobilization or fixation. Fractures fixed in a malreduced (misaligned) position can require revision surgery. However, because this has been a relatively rare occurrence, little is known about the complications that can occur after such surgery. We reviewed all adult closed ankle fractures that underwent revision surgery for technical failure in a regional trauma hospital from January 2007 to January 2010. Those with open fractures and those who required external fixation at any point in their treatment were excluded. Nine patients underwent revision surgery during the study period. Of these 9 patients, 3 (33%) developed a deep infection, all with positive microbiology cultures for methicillin-sensitive Staphylococcus aureus. Each of these patients underwent removal of the metalwork and wound debridement, followed by plastic surgery free flap coverage. In addition to the 3 infection cases, those with noninfected complications included 1 patient (11%) with chronic regional pain syndrome, 1 (11%) with failure of plate fixation, and 1 (11%) with persistent pain requiring arthroscopy and debridement. The overall incidence of complications was 66.67% in this group of 9 patients who had undergone revision surgery for the treatment of a malreduced malleolar ankle fracture. Although our observational study involved a small subset of patients who had undergone surgical repair for ankle fracture, we suggest that if revision surgery will be undertaken, the high incidence of infection and the potential need for plastic surgery should be highlighted during the consent process before the original, open reduction internal fixation procedure.

Stair-step artifact seen in coronal and sagittal reformatted images because of misalignment of computed tomography tube, in a positron emission tomography/computed tomography scanner

Reconstruction artifacts often affect the image quality. An unusual wavy imaging pattern was seen on computed tomography (CT) part of positron emission tomography/CT, on sagittal and coronal images. This pattern was corrected on realignment of CT tube. This artifact, popularly known as stair step artifact, is rarely cited in the literature and our case generates a practical scenario of how it affects the image quality and how it is corrected.

Shift work and circadian dysregulation of reproduction

Health impairments, including reproductive issues, are associated with working nights or rotating shifts. For example, shift work has been associated with an increased risk of irregular menstrual cycles, endometriosis, infertility, miscarriage, low birth weight or pre-term delivery, and reduced incidence of breastfeeding. Based on what is known about circadian regulation of endocrine rhythms in rodents (and much less in humans), the circadian clock is an integral regulatory part of the reproductive system. When this 24-h program is disordered by environmental perturbation (such as shift work) or genetic alterations, the endocrine system can be impaired. The purpose of this review is to explore the hypothesis that misalignment of reproductive hormones with the environmental light-dark cycle and/or sleep-wake rhythms can disrupt menstrual cycles, pregnancy, and parturition. We highlight the role of the circadian clock in regulating human reproductive physiology and shift work-induced pathology within each step of the reproductive axis while exploring potential mechanisms from the animal model literature. In addition to documenting the reproductive hazards of shift work, we also point out important gaps in our knowledge as critical areas for future investigation. For example, future studies should examine whether forced desynchronization disrupts gonadotropin secretion rhythms and whether there are sleep/wake schedules that are better or worse for the adaptation of the reproductive system to shift work. These studies are necessary in order to define not only whether or not shift work-induced circadian misalignment impairs reproductive capacity, but also to identify strategies for the future that can minimize this desynchronization.

Effect of Misalignment between Hospital and Provincial Formularies on Medication Discrepancies at Discharge: PPITS (Proton Pump Inhibitor Therapeutic Substitution) Study

BACKGROUND

Medication discrepancies may occur on admission, transfer, or discharge from hospital. Therapeutic interchange within a drug class is a common practice in hospitals, and orders for specific proton pump inhibitors (PPIs) are often substituted with the hospital's formulary PPI through therapeutic interchange protocols. Rabeprazole is the PPI on the formulary of the British Columbia PharmaCare program. However, different PPIs may appear on the formularies of the province's hospitals. This misalignment and use of therapeutic interchange may lead to increased rates of medication discrepancies at the time of discharge.

OBJECTIVE

To evaluate the effect of formulary misalignment for PPIs between St Paul's Hospital in Vancouver and the British Columbia PharmaCare program and use of therapeutic interchange on the occurrence of medication discrepancies at discharge.

METHODS

A cohort chart review was performed to compare discharge discrepancy rates for PPI orders between 2 periods: June 2006 to June 2008, when the same PPI appeared on the hospital and provincial formularies, and July 2008 to July 2010, when the designated PPIs differed between the hospital and provincial formularies. Data for the first study period were used to establish the baseline discharge discrepancy rate, and data for the later period represented the discharge discrepancy rate in the presence of misalignment between the hospital and PharmaCare formularies.

RESULTS

The discharge discrepancy rate for PPIs was 27.3% (24/88) when the 2 formularies were aligned and 49.1% (81/165) when the formularies were misaligned. This represents an absolute increase of 21.8 percentage points in the risk of discharge discrepancies (95% confidence interval 9.8-33.9 percentage points; p < 0.001) when the hospital and provincial formularies were misaligned and the hospital's therapeutic interchange protocol was used.

CONCLUSIONS

Misalignment between the PPIs specified in the hospital and provincial formularies, combined with use of therapeutic interchange, was associated with a significant increase in medication discrepancies at discharge.