Three-dimensional histology reveals dissociable human hippocampal long-axis gradients of Alzheimer's pathology

INTRODUCTION

Three-dimensional (3D) histology analyses are essential to overcome sampling variability and understand pathological differences beyond the dissection axis. We present Path2MR, the first pipeline allowing 3D reconstruction of sparse human histology without a magnetic resonance imaging (MRI) reference. We implemented Path2MR with post-mortem hippocampal sections to explore pathology gradients in Alzheimer's disease.

METHODS

Blockface photographs of brain hemisphere slices are used for 3D reconstruction, from which an MRI-like image is generated using machine learning. Histology sections are aligned to the reconstructed hemisphere and subsequently to an atlas in standard space.

RESULTS

Path2MR successfully registered histological sections to their anatomic position along the hippocampal longitudinal axis. Combined with histopathology quantification, we found an expected peak of tau pathology at the anterior end of the hippocampus, whereas amyloid-beta (Aβ) displayed a quadratic anterior-posterior distribution.

CONCLUSION

Path2MR, which enables 3D histology using any brain bank data set, revealed significant differences along the hippocampus between tau and Aβ.

HIGHLIGHTS

Path2MR enables three-dimensional (3D) brain reconstruction from blockface dissection photographs. This pipeline does not require dense specimen sampling or a subject-specific magnetic resonance (MR) image. Anatomically consistent mapping of hippocampal sections was obtained with Path2MR. Our analyses revealed an anterior-posterior gradient of hippocampal tau pathology. In contrast, the peak of amyloid-beta (Aβ) deposition was closer to the hippocampal body.

Toward a theory of perspective perception in pictures

This paper reviews projection models and their perception in realistic pictures, and proposes hypotheses for three-dimensional (3D) shape and space perception in pictures. In these hypotheses, eye fixations, and foveal vision play a central role. Many past theories and experimental studies focus solely on linear perspective. Yet, these theories fail to explain many important perceptual phenomena, including the effectiveness of nonlinear projections. Indeed, few classical paintings strictly obey linear perspective, nor do the best distortion-avoidance techniques for wide-angle computational photography. The hypotheses here employ a two-stage model for 3D human vision. When viewing a picture, the first stage perceives 3D shape for the current gaze. Each fixation has its own perspective projection, but, owing to the nature of foveal and peripheral vision, shape information is obtained primarily for a small region of the picture around the fixation. As a viewer moves their eyes, the second stage continually integrates some of the per-gaze information into an overall interpretation of a picture. The interpretation need not be geometrically stable or consistent over time. It is argued that this framework could explain many disparate pictorial phenomena, including different projection styles throughout art history and computational photography, while being consistent with the constraints of human 3D vision. The paper reviews open questions and suggests new studies to explore these hypotheses.

Quantifying Facial Distortion in Modern Digital Photography

BACKGROUND

Advancements in digital cameras and the advent of smartphones have magnified the importance of clinical photography in facial plastic surgery. Here, we aim to examine the effect of different camera types, focal lengths, and distances from subjects on facial distortion.

METHODS

Twelve subjects underwent a series of frontal photographs using a smartphone camera and a full-frame digital single-lens reflex camera. Photos were captured at six distances from the subject. Seven focal lengths were used at each distance for the full-frame camera. Measurements of facial landmarks were made for each photo, with those made at 60 inches using the full-frame camera considered the gold standard and used for comparison.

RESULTS

Distortion of facial features using the full-frame camera occurred when photos were captured 8 inches away using short focal lengths. A 12%-19% increase in vertical stretching of the midface occurred when using focal lengths of 24, 35, and 50 mm (p < 0.05 for all). The same features were distorted when a smartphone camera was used at 8 inches (18% increase, p < 0.01) and 12 inches (12% increase, p < 0.03).

CONCLUSIONS

Distortion of midfacial features using both smartphones and full-frame cameras occurs with short, 'selfie' distances between the camera and subject.

LEVEL OF EVIDENCE

2 Laryngoscope, 134:1234-1238, 2024.

Boosting Resilience: Photovoice as a Tool for Promoting Well-Being, Social Cohesion, and Empowerment Among the Older Adult During the COVID-19 Pandemic

This paper examines how older adults who participated in an online photovoice-based group intervention program reported their experience. In a qualitative-phenomenological study, in which 13 older-adult people participated, data were collected through semi-structured in-depth interviews and analyzed through content analysis. The findings point to three central themes: a) Challenges-technical difficulties, difficulties in finding a subject for photography, investing time in photography, and an emotional-intellectual effort to put their experience into photography; b) Growth: New knowledge and skills-acquiring new knowledge, acquiring skills, experiencing skills regardless of age, and empowerment; c) Meaning-reflexivity, the ability to project feelings onto images, connection to the outside world, mindfulness, ability to choose, creativity, and critical consciousness. The findings share the way in which the use of creative visual engagement with photography contributed to coping with various challenges and enabled various gains within the process among the older-adult participants.

Using AI Text-to-Image Generation to Create Novel Illustrations for Medical Education: Current Limitations as Illustrated by Hypothyroidism and Horner Syndrome

Our research letter investigates the potential, as well as the current limitations, of widely available text-to-image tools in generating images for medical education. We focused on illustrations of important physical signs in the face (for which confidentiality issues in conventional patient photograph use may be a particular concern) that medics should know about, and we used facial images of hypothyroidism and Horner syndrome as examples.

Determination of output factor for CyberKnife using scintillation dosimetry and deep learning

Objective. Small-field dosimetry is an ongoing challenge in radiotherapy quality assurance (QA) especially for radiosurgery systems such as CyberKnifeTM. The objective of this work is to demonstrate the use of a plastic scintillator imaged with a commercial camera to measure the output factor of a CyberKnife system. The output factor describes the dose on the central axis as a function of collimator size, and is a fundamental part of CyberKnife QA and integral to the data used in the treatment planning system.Approach. A self-contained device consisting of a solid plastic scintillator and a camera was build in a portable Pelicase. Photographs were analysed using classical methods and with convolutional neural networks (CNN) to predict beam parameters which were then compared to measurements.Main results. Initial results using classical image processing to determine standard QA parameters such as percentage depth dose (PDD) were unsuccessful, with 34% of points failing to meet the Gamma criterion (which measures the distance between corresponding points and the relative difference in dose) of 2 mm/2%. However, when images were processed using a CNN trained on simulated data and a green scintillator sheet, 92% of PDD curves agreed with measurements with a microdiamond detector to within 2 mm/2% and 78% to 1%/1 mm. The mean difference between the output factors measured using this system and a microdiamond detector was 1.1%. Confidence in the results was enhanced by using the algorithm to predict the known collimator sizes from the photographs which it was able to do with an accuracy of less than 1 mm.Significance. With refinement, a full output factor curve could be measured in less than an hour, offering a new approach for rapid, convenient small-field dosimetry.

The Power and Potential of Photography as a Therapeutic Modality for Children with Life-Impacting Illnesses

Objectives: Art is being increasingly appreciated for its healing capacity in pediatric medicine. However, while mediums like music and painting have already been widely integrated into children's health institutions across the nation, photography is an artform that is greatly understudied in its application to medicine. As a non-profit organization with a 17-year history of providing free in-hospital/in-hospice photography sessions to the families of children with life-impacting illnesses, we set out to evaluate the therapeutic capacity of this intervention. Methods: Individuals having received Moment by Moment Photography's services from June 2022 to January 2023 were invited to complete a five-question survey assessing the nature and quality of their photography session and the resulting photographs they received. Results: All but one of the 177 participants found the photographs impactful, and the overwhelming majority (95.5%) of participants rated the value of the photographs as high as possible (5/5 on a Likert scale). Further, a dozen themes, including love, share, connect, and fight, among others, were identified that articulate the diversity of ways that "impact" manifested in families. Conclusion: Together, these results clearly support the benefit of photography as a legacy making and therapeutic medium.

Contemplation

Description Before embarking on a busy workday, take a moment to appreciate the sunrise. Living near the beach is a privilege that reminds me that you can find the calm necessary to face the demands of your role as a division research director through a few minutes of meditation during your commute. The footprints in the sand symbolize the work accomplished with residents, faculty, and staff the previous day. The pier represents the strength of remaining stable even amidst turbulent waves, which symbolize the ever-changing requests and priorities. The rising sun embodies self-energy and excitement for another day, knowing that "above all else, we are committed to the care and improvement of human life," which makes it all worthwhile. Take a deep breath in and exhale.

Accuracy, acceptability and feasibility of photography for use in trachoma surveys: a mixed methods study in Tanzania

BACKGROUND

Photography could be used to train individuals to diagnose trachomatous inflammation-follicular (TF) as trachoma prevalence decreases and to ensure accurate field TF grading in trachoma prevalence surveys. We compared photograph and field TF grading and determined the acceptability and feasibility of eyelid photography to community members and trachoma survey trainers.

METHODS

A total of 100 children ages 1-9 y were examined for TF in two Maasai villages in Tanzania. Two images of the right everted superior tarsal conjunctiva of each child were taken with a smartphone and a digital single-lens reflex (DSLR) camera. Two graders independently graded all photos. Focus group discussions (FGDs) were conducted with community members and Tropical Data trainers.

RESULTS

Of 391 photos, one-fifth were discarded as ungradable. Compared with field grading, photo grading consistently underdiagnosed TF. Compared with field grading, DSLR photo grading resulted in a higher prevalence and sensitivity than smartphone photo grading. FGDs indicated that communities and trainers found photography acceptable and preferred smartphones to DSLR in terms of practicalities, but image quality was of paramount importance for trainers.

CONCLUSIONS

Photography is acceptable and feasible, but further work is needed to ensure high-quality images that enable accurate and consistent grading before being routinely implemented in trachoma surveys.

Revealing the Concealed: Alternatives to Random Dots for Stereograms

Investigations of stereoscopic depth perception were transformed via the use of computer-generated random-dot stereograms in the 1960s. They realized Wheatstone's wish of demonstrating binocular depth without monocular object recognition, and they have been the dominant stimulus for studying stereopsis since then. Alternative carrier patterns to random dots, based on graphics, photographs, and their combinations, are presented as anaglyphs and for free fusion. A wider range of concealed patterns can be revealed with these alternatives, and presenting them as anaglyphs can yield patterns that have visual appeal independent of the depth they conceal.

Three-dimensional histology reveals dissociable human hippocampal long axis gradients of Alzheimer's pathology

INTRODUCTION

Three-dimensional (3D) histology analyses are essential to overcome sampling variability and understand pathological differences beyond the dissection axis. We present Path2MR, the first pipeline allowing 3D reconstruction of sparse human histology without an MRI reference. We implemented Path2MR with post-mortem hippocampal sections to explore pathology gradients in Alzheimer's Disease.

METHODS

Blockface photographs of brain hemisphere slices are used for 3D reconstruction, from which an MRI-like image is generated using machine learning. Histology sections are aligned to the reconstructed hemisphere and subsequently to an atlas in standard space.

RESULTS

Path2MR successfully registered histological sections to their anatomical position along the hippocampal longitudinal axis. Combined with histopathology quantification, we found an expected peak of tau pathology at the anterior end of the hippocampus, while amyloid-β displayed a quadratic anterior-posterior distribution.

CONCLUSION

Path2MR, which enables 3D histology using any brain bank dataset, revealed significant differences along the hippocampus between tau and amyloid-β.

Comparing image quality and trachoma detection across three camera types from a survey in Kongwa, Tanzania

BACKGROUND

There is an increasing demand for photography for trachoma prevalence surveys. In previous studies, digital single lens reflex (DSLR) images were superior to smartphone images, but newer-model smartphones and/or lens attachments may be able to bridge this gap. This study compares the image quality and ability to detect trachomatous inflammation - follicular (TF) of three camera types: a DSLR Nikon camera, an iPhone SE and an iPhone 13 Pro with a cell scope.

METHODS

We surveyed 62 children ages 1-7 y from two Tanzanian communities. Upper tarsal conjunctiva images of both eyes were graded for TF by two standardized graders. The McNemar's test and a logistic regression model were used for analyses.

RESULTS

The DSLR camera malfunctioned during the study, thus the iPhone SE and iPhone 13 Pro with cell scope were both more likely to take high-quality, gradable photographs (88% and 86%, respectively) compared with the DSLR camera (69%) (p<0.001 and p=0.02, respectively). TF was detected in gradable images from the iPhone SE (8.8%) and iPhone 13 Pro with cell scope (9.0%) at the same rate (p=1.0) as images from the DSLR camera (9.7%).

CONCLUSION

Smartphones with high-quality image capture, like the iPhone SE/13 Pro, have the potential for use in trachoma surveys if the proportion of gradable images can be improved.

The PhotoVoice method for collaborating with people with lived experience of mental health conditions to strengthen mental health services

There is a growing recognition of the benefits of collaborating with people with lived experience (PWLE) of mental health conditions in mental health research and implementation of services. Such collaboration has been effective in reducing mental health stigma and improving the quality of mental health care. Here, we describe using PhotoVoice as a collaborative method in which PWLE use visual narratives to tell their recovery stories for promoting social contact, debunking myths and reducing stigma. First, we outline the framework of this collaboration, drawing on theories from medical anthropology and social psychology and focusing on reducing mental health stigma among primary healthcare workers. Then, we describe the process using our learnings from implementing PhotoVoice in Nepal, Ethiopia and Uganda. We highlight collaboration in five key steps with associated considerations: (1) identifying PWLE for collaboration; (2) training in photography, distress management and presentation skills; (3) developing a photographic recovery story; (4) training healthcare workers using the PhotoVoice narratives; and (5) ongoing support of mental health systems strengthening in collaboration with PWLE. Then, we critically reflect on the process, highlighting the benefits and challenges to the participants and researchers, thereby paving the way for expanding collaborations with PWLE using the PhotoVoice method.

[Fighting against erasure: a community archive of photos of the São Daniel Profeta Church in Manguinhos]

This article describes the construction and development of tangible and intangible ties that link the São Daniel Profeta Church to its community in the territory of Manguinhos by tracing the history of the community's photo archive through a selection of photographs that were digitized as part of the heritage education project carried out by the São Daniel Profeta Church Preservation Committee between 2019 and 2021. These images improved understanding of the affective relationships which were established and the strategy by the Catholic Church and the government to insert themselves into favela communities during the second half of the twentieth century in the city of Rio de Janeiro.

Superfund Sites and the Bipartisan Infrastructure Law in New Jersey State: A Photo Essay

In 2021, the Infrastructure Investment and Jobs Act, also known as the Bipartisan Infrastructure Law (BIL), became law, with one component being an investment to clean-up Superfund and Brownfield sites. Through BIL funding, the Environmental Protection Agency announced $3.5 billion to clean-up Superfund sites that have been awaiting funding for years in mostly historically underserved communities. As in many states, the 3 Superfund sites used as examples in this essay are in a metropolitan or surrounding area and in residential communities. The photos in this essay help highlight how hazardous waste sites have come to look like normal industrial sites and that communities are often unaware of the dangerous exposures they face. The author suggests that in the age of social media, taking pictures and documentation of hazardous waste sites today in our communities can help mobilize public awareness and drive action to be taken toward delayed clean-up.

Cârța Monastery

Description The Cârța Monastery, a former Cistercian monastery, is pictured here from one of its sides, conjuring the romanticism that is beloved in medieval ruins. The photo was taken on a sunny fall afternoon in the Țara Făgărașului region of Romania in southern Transylvania. Cârța Monastery was started around 1202 by a group of Cistercian monks from Egres Abbey in the then-kingdom of Hungary. Cistercian architecture is considered some of the most beautiful of the Middle Ages, and walking the grounds of the Monastery indeed evoked a profound sense of gratitude, awe, and peace in the shadow of its beauty that I can call up to this day. Such experiences contribute to our resilience as individuals, and as communities, and reminds us as global members of society that seeking to consistently better ourselves and our planet is a constant evolution.

Digital Shade Matching in Dentistry: A Systematic Review

The pursuit of aesthetic excellence in dentistry, shaped by societal trends and digital advancements, highlights the critical role of precise shade matching in restorative procedures. Although conventional methods are prevalent, challenges such as shade guide variability and subjective interpretation necessitate a re-evaluation in the face of emerging non-proximity digital instruments. This systematic review employs PRISMA protocols and keyword-based search strategies spanning the Scopus®, PubMed.gov, and Web of ScienceTM databases, with the last updated search carried out in October 2023. The study aimed to synthesise literature that identified digital non-proximity recording instruments and associated colour spaces in dentistry and compare the clinical outcomes of digital systems with spectrophotometers and conventional visual methods. Utilising predefined criteria and resolving disagreements between two reviewers through Cohen's kappa calculator, the review assessed 85 articles, with 33 included in a PICO model for clinical comparisons. The results reveal that 42% of studies employed the CIELAB colour space. Despite the challenges in study quality, non-proximity digital instruments demonstrated more consistent clinical outcomes than visual methods, akin to spectrophotometers, emphasising their efficacy in controlled conditions. The review underscores the evolving landscape of dental shade matching, recognising technological advancements and advocating for methodological rigor in dental research.

Evaluation of Mobile and Digital Single-Lens Reflex Photography for Facial Surgical Analysis

OBJECTIVES

High-quality perioperative photography is imperative to good surgical planning in facial reconstructive and aesthetic surgery. We explore the utility of an add-on smartphone telephoto lens to avoid the distortions noted in prior studies using smartphone cameras.

METHODS

Standard perioperative photographs of the same subject were taken with three distinct cameras using a dual-ring light setup. The three camera setups iPhone 11 alone, iPhone 11 with the 58 Moment telephoto lens attachment, and a D3300 Nikon DSLR APS-C sensor camera with a 60 mm NIKKOR F2.8G ED macro lens were compared using a 47-question online survey consisting of demographic and image-specific questions sent to plastic surgeons.

RESULTS

Forty-nine facial plastic surgeons completed the survey. The iPhone 11 alone was identified as having the lowest quality for central/peripheral distortion (83%), columella/caudal septum/alar anatomy (58.3%), and skin quality (38.3%). With the addition of the telephoto lens, the ability to assess all categories was significantly improved. 53.1% (n = 26) of respondents found the iPhone 11 + 58 mm telephoto lens setup to be the most useful for perioperative surgical planning.

CONCLUSIONS

Smartphone photography with the addition of a telephoto lens can offer a comparable option to the DSLR with regard to photo quality and detail.

SUMMARY

A telephoto add-on lens is an effective solution to overcome the central distortion seen in images taken by the iPhone for perioperative photography. This photo quality was found to be comparable to that of traditional DSLR cameras in our survey study.

LEVEL OF EVIDENCE

3 Laryngoscope, 133:2590-2596, 2023.

Comparison of Three Handheld Fundus Cameras for Assessment of the Vertical Cup-To-Disk Ratio

Purpose To compare the quality of optic nerve photographs from three different handheld fundus cameras and to assess the reproducibility and agreement of vertical cup-to-disk ratio (VCDR) measurements from each camera. Methods Adult patients from a comprehensive ophthalmology clinic and an intravitreous injection clinic in northern Thailand were recruited for this cross-sectional study. Each participant had optic nerve photography performed with each of 3 handheld cameras: the Volk iNview, Volk Pictor Plus, and Peek Retina. Images were graded for VCDR in a masked fashion by two photo-graders and images with > 0.2 discrepancy in VCDR were assessed by a third photo-grader. Results A total of 355 eyes underwent imaging with three different handheld fundus cameras. Optic nerve images were judged ungradable in 130 (37%) eyes imaged with Peek Retina, compared to 36 (10%) and 55 (15%) eyes imaged with the iNview and Pictor Plus, respectively. For 193 eyes with gradable images from all 3 cameras, inter-rater reliability for VCDR measurements was poor or moderate for each of the cameras, with intraclass correlation coefficients ranging from 0.41 to 0.52. A VCDR ≥ 0.6 was found in 6 eyes on iNview images, 9 eyes on Pictor Plus images, and 3 eyes on Peek images, with poor agreement between cameras (e.g., no eyes graded as VCDR ≥ 0.6 on images from both the iNview and Pictor Plus). Conclusions Inter-rater reliability of VCDR grades from 3 handheld cameras was poor. Cameras did not agree on which eyes had large VCDRs.

Rapid imaging in the field followed by photogrammetry digitally captures the otherwise lost dimensions of plant specimens

Premise

We recognized the need for a customized imaging protocol for plant specimens at the time of collection for the purpose of three-dimensional (3D) modeling, as well as the lack of a broadly applicable photogrammetry protocol that encompasses the heterogeneity of plant specimen geometries and the challenges introduced by processes such as wilting.

Methods and Results

We developed an equipment list and set of detailed protocols describing how to capture images of plant specimens in the field prior to their deformation (e.g., with pressing) and how to produce a 3D model from the image sets in Agisoft Metashape Professional.

Conclusions

The equipment list and protocols represent a foundation on which additional improvements can be made for specimen geometries outside of the range of the six types considered, and an easy entry into photogrammetry for those who have not previously used it.

Pics or It Didn't Happen: Reading Photographs in the Reef Tank Community

In 1961, Lee Chin Eng jumpstarted the reef hobby, a hobby dedicated to the modeling of coral reefs in captivity, with an article in Tropical Fish Hobbyist. He illustrated the article with eight photographs; these images were meaningful to the hobbyists viewing them and they conveyed both information about the tank system and also claims about Lee's expertise. This paper examines three genres of photographs-landscapes, active, and passive portraiture-that appeared in Lee's article and how and why they have proliferated in the reef hobbyist community over the last sixty years. By tracing the history of these genres, we can better understand natural knowledge producers rely on photographs to exchange knowledge and cement community identity.

COVID: The Sound of Silence

Description COVID brought its toll of deaths. Something the human race has not experienced in recent times. Something almost unimaginable in the modern world! But having joined a new hospital and moved to a sleepy old town, COVID gave me a sense of solitude I have not experienced for eons. There are times you wonder at the endless ocean in front of you and communicate with your inner soul.

Different Methods for Assessing Tooth Colour-In Vitro Study

Colour assessment using digital methods can yield varying results, and it is important for clinicians to recognize the potential variability intra and inter-device. This study aimed to compare the L*a*b* values of VITA Classical (VC) and VITA Toothguide 3D-MASTER (VM) guides using two methods, SpectroShade (SS) and eLAB. Thirty-four measurements per tab were performed by a single operator across three batches of each guide. Intraclass correlation coefficients (ICC) between batches were calculated. Values <0.5, 0.5-0.75, 0.75-0.9, and >0.90 were classified as poor, moderate, good, and excellent reliability, respectively. Results were reported as mean and standard deviation of the L*a*b* values and respective colour differences (ΔE00) for each tab and method. Statistical analyses were performed with an independent t-test, α = 0.05. ICC values between batches were excellent for all L*a*b*, except for a* component in eLAB. There were statistically significant differences between methods in most L*a*b* values. The intra-device mean ΔE00 was 0.5 ± 0.6 for VC, 0.5 ± 0.8 for VM in SS, 1.1 ± 0.8 for VC, 1.1 ± 0.9 for VM in eLAB. The mean ΔE00 inter-device was 4.9 ± 1.7 for VC, 5.0 ± 1.7 for VM. Both methods demonstrated good internal consistency, with high ICC values and low intra-device colour differences, but exhibited high variability between methods, higher for a* the component.

Nature Photographs as Complementary Care in Chemotherapy: A Randomized Clinical Trial

The incidence of cancer cases is increasing worldwide, and chemotherapy is often necessary as part of the treatment for many of these cases. Nature-based interventions have been shown to offer potential benefits for human well-being.

OBJECTIVE

This study aims to investigate the outcome of nature images on clinical symptom management related to chemotherapy.

METHODS

A randomized clinical trial was conducted in an outpatient cancer unit of a private hospital in Brazil, with 173 participants over the age of 18 who were undergoing chemotherapy and had signed an informed consent form. The intervention consisted of the presentation of a 12-min video featuring nature images categorized under the themes of Tranquility, Beauty, Emotions Up, or Miscellany. Images were sourced from the e-Nature Positive Emotions Photography Database (e-NatPOEM), a publicly available collection of affectively rated images. Sociodemographic and clinical data, as well as the participants' connection to nature, were investigated. The Positive Affect/Negative Affect Scale (PANAS) and the Edmonton Symptom Assessment System (ESAS) were applied pre- and post-intervention.

RESULTS

Data showed very strong evidence of a reduction in negative affect for the intervention group (p < 0.001) and moderate evidence for the control group (p = 0.034). There was also a significant reduction in the intervention group for pain (p < 0.001), tiredness (p = 0.002), sadness (p < 0.001), anxiety (p < 0.001), and appetite (p = 0.001). The Beauty video had the best performance, while the Tranquility video showed no significant improvement in any of the symptoms evaluated. These findings suggest that images of nature may be a valuable tool to help control clinical and psychological symptoms in cancer patients undergoing chemotherapy.

Show and Tell: Photography and Storytelling to Better Understand the End-of-Life Experience of Families in the Intensive Care Unit

End-of-life in the Intensive Care Unit (ICU) is common, costly, and can contribute to negative health outcomes for bereaved family members. Insufficient understanding of the family experience results in poor quality, highly variable care riddled with deficiencies including effective identification and application of evidence-based clinical interventions. Successfully managing the multitude of transitions, for example changes in family role or personal identity requires creative practice guided by theory. This project supports the feasibility of using peri-mortem photographs captured by family members with story-telling and a standardized measurement of grief to explore the family experience of end-of-life in the ICU. Project findings reveal shared experiential themes and emphasize the value of photography and storytelling as meaning-making interventions for families. Further study to generalize findings and develop additional preventative and therapeutic interventions at and beyond end-of-life in the ICU is needed to better meet family needs and improve their health outcomes.

Evolving the Cybersecurity of Clinical Photography in Plastic Surgery

Point-of-care photography and photo sharing optimize patient outcomes and facilitate remote consultation imperative for resident surgeons. This literature review and external pilot survey study highlight the risks associated with current practices concerning patient privacy and biometric security. In a survey of 30 plastic surgeon residents and attendings, we found that the majority took photos of patients with their iPhones and shared them with colleagues via Apple iMessage. These findings corroborate previous reports and highlight a lack of physician user acceptance of secure photo-sharing platforms. Finally, we frame a successful example from the literature in the context of a postulated framework for institutional change. Prioritizing the privacy and safety of patients requires a strategic approach that preserves the ease and frequency of use of current practices.

Clinical metrics and tools for provider assessment and tracking of trigonocephaly

OBJECTIVE

Quantitative measurements of trigonocephaly can be used to characterize and track this phenotype, which is associated with metopic craniosynostosis. Traditionally, trigonocephaly metrics were extracted from CT scans; however, this method exposes patients to ionizing radiation. Three-dimensional optical scans are another option but are not routinely available in most outpatient settings. Recently, the authors developed semiautomated artificial intelligence algorithms that extract craniometric data from orthogonal 2D photographs. Although 2D photographs are safe, inexpensive, and straightforward to obtain, the accuracy of photograph-based craniometrics in comparison to CT and 3D optical scan correlates has not been established. In this study the authors compared the classification power of 2D photograph-based metrics of trigonocephaly with four CT-based metrics and one 3D optical scan-based metric in a heterogeneous series of patients who presented to an outpatient craniofacial clinic.

METHODS

In this study the authors performed retrospective craniometric analyses of patient 2D photographs, 3D optical scans, and CT scans. Imaging-derived craniometrics include the 2D photograph-based anterior arc angle (AAA2D-photo), anterior-posterior ratio (APR2D-photo), and anterior-middle ratio (AMR2D-photo); the CT-based anterior arc angle (AAACT), metopic index (MICT), endocranial-bifrontal angle (eBFACT), and interfrontal angle (IFACT); and the 3D optical scan-based anterior arc angle (AAA3D-optical). Receiver operating characteristics (ROCs) were used to identify craniometrics strongly descriptive of trigonocephaly. Interrater comparisons were made between paired trigonocephaly measurements obtained from photographs and either CT scans or 3D optical scans.

RESULTS

There were 13 photograph-based and CT-based pairs and 22 paired measurements from 2D photographs and 3D optical scans. AAA displayed the strongest classification capacity across all three imaging modalities. Significant agreement was observed between AAACT and AAA2D-photo (intraclass correlation coefficient [ICC] = 0.68 [95% CI 0.24-0.89], p = 0.0035), and AAA3D-optical and AAA2D-photo (ICC = 0.70 [95% CI 0.41-0.87], p < 0.0001). There was no significant correlation between APR2D-photo or AMR2D-photo and conventional CT-based metrics describing longitudinal width ratios (MICT).

CONCLUSIONS

Photograph-based craniometrics are powerful tools that can be used to quantify the severity of trigonocephaly and exhibit high concordance with standard measurements derived from CT scans and 3D optical scans. The authors developed and freely share a research-use application to calculate trigonocephaly metrics from 2D photographs. Given the availability of digital photography, lack of ionizing radiation, and low cost of photograph-based craniometric derivation, this technique may be useful to supplement routine ambulatory care and objectively track outcomes following treatment.

Ideal Nasal Preferences: A Quantitative Investigation with 3D Imaging in the Iranian Population

Background  Though in facial plastic surgery, the ideal nasal characteristics are defined by average European-American facial features known as neoclassical cannons, many ethnicities do not perceive these characteristics as suitable. Methods  To investigate the preferences for nasofrontal angle, nasolabial angle, dorsal height, alar width, and nasal tip projection, manipulated pictures of one male and one female model were shown to 203 volunteer patients from a tertiary university hospital's facial plastic clinic. Results  The most aesthetically preferred nasofrontal angles were 137.64 ± 4.20 degrees for males and 133.55 ± 4.53 degrees for females. Acute nasofrontal angles were more desirable in participants aged 25 to 44. The most preferred nasolabial angles were 107.56 ± 5.20 degrees and 98.92 ± 4.88 degrees, respectively. Volunteers aged 19 to 24 preferred more acute male nasolabial angles. A straight dorsum was the most desirable in both genders (0.03 ± 0.78 and 0.26 ± 0.75 mm, respectively). The ideal male and female alar widths were -0.51 ± 2.26 and -1.09 ± 2.18 mm, respectively. More 45- to 64-year-old volunteers preferred alar widths equal to intercanthal distance. The ideal female and male tip projections were 0.57 ± 0.01 and 0.56 ± 0.01, respectively. Conclusion  Results indicate that the general Iranian patients prefer thinner female noses with wider nasofrontal angles for both genders. However, the ideal nasolabial angles, dorsal heights, and tip projections were consistent with the neoclassical cannons. Besides ethnic differences, the trend of nasal beauty is also affected by gender, age, and prior history of aesthetic surgery.

Resilience

Description On one of the busiest parkways, in the midst of a spring drought, despite the lack of soil a sunflower blooms. This tiny beacon of hope represents the enduring spirit of humanity managing to struggle through this recent global pandemic. For me as a program director, it conjures to mind my graduating family medicine residents. Due to COVID-19, they had to pull extra shifts in the hospital, flip patients in the ICU, and witnessed death on an unprecedented scale. Despite this adversity, they continue to grow professionally, thrive individually, and show the world their sunny smiling faces.

'Picture imperfect': the motives and uses of patient photography in the asylum

In the nineteenth century, photography became common in psychiatric asylums. Although patient photographs were produced in large numbers, their original purpose and use are unclear. Journals, newspaper archives and Medical Superintendents' notes from the period 1845-1920 were analysed to understand the reasons behind the practice. This revealed: (1) empathic motivation: using photography to understand the mental condition and aid treatment; (2) therapeutic focus on biological processes: using photography to detect biological pathologies or phenotypes; and (3) eugenics: using photography to recognise hereditary insanity, aimed at preventing transmission to future generations. This reveals a conceptual move from empathic intentions and psychosocial understandings to largely biological and genetic explanations, providing context for contemporary psychiatry and the study of heredity.

Melanoma diagnosis at a specialist dermatology practice without the use of photographic surveillance

BACKGROUND/OBJECTIVE

Photographic aides are increasingly used in melanoma surveillance. We report melanoma characteristics detected using traditional surveillance without photographic technologies.

METHODS

Retrospective study of melanomas diagnosed by three dermatologists at a private dermatology practice over 7 years. Patients underwent full skin examinations with dermoscopy and suspect lesions were excised or biopsied. Total body photography (TBP) and serial digital dermoscopic imaging (SDDI) were not used. Patient demographics, melanoma subtype and thickness, location, biopsy technique and keratinocyte cancers diagnosed at the same visit were recorded. Ratio of in situ to invasive melanomas was calculated. Melanoma risk factors were recorded for 69 randomly-selected patients.

RESULTS

492 patients were diagnosed with 615 melanomas during 579 visits. 505 (82%) were in situ (in situ to invasive ratio of 4.6:1). Of the invasive melanomas, 85.5% had a Breslow thickness <0.8 mm, 10 (9.1%) 0.8-1 mm and 6 (5.5%) >1 mm. 43.3% of in situ melanomas were lentiginous or lentigo maligna and 41.6% were superficial spreading melanomas (SSM). Of invasive melanomas, 24.3% were lentigo maligna melanoma and 59.5% were SSM. 48.4% of melanomas were diagnosed by shave procedures. Where risk factors were known, 25% were very-high-risk and 43% had a history of melanoma. Keratinocyte carcinoma was diagnosed by biopsy at 26.1% of visits. Studies using TBP and/or SDDI report in situ to invasive ratios of 0.59:1 to 2.17:1.

CONCLUSION

Tradiational melanoma surveillance with immediate biopsy of suspect lesions results in high in situ to invasive ratios. Studies using photographic surveillance show lower ratios of in situ to invasive disease.

Insult to Injury? Women and Mental Disorder in Italian Photography and Visual Culture

This article shows how representations of women labeled as mentally ill in photography in Italy have been framed and marked by forms of violence, and how they continue to shape perceptions of women. It argues that the Italian case is a particularly interesting and revealing one, and that such images need to be viewed in the context of the shared status of photography and psychiatry as contemporarily "modern" inventions that have played important roles in reinforcing or contesting violent and institutionalized systems of surveillance and oppression of women.

[Photographing to advance, the use of photography in psychotherapy]

The practice of the clinical psychologist in child psychiatry can be a perilous task. His balance, as precarious as it may be, lies in listening to and observing the patient, but also in the use of precious tools of which therapeutic mediations are a part. They allow to experiment a sensory-motor anchorage and bring a multidimensional vision necessary to the comprehension of the subject and his suffering. By creating an intermediary space between the I and the You, the outside and the inside, they determine a place where the psychotherapeutic work can take place.

Maggot Treatment of Necrotic Toe Developed After Traumatic Subtotal Amputation

Maggot debridement therapy (MDT) has been used for years in the treatment of chronic wounds and necrotic tissues. We report a case of subtotally amputated third toe that was treated with MDT after reattachment and developing complete necrosis. The necrotic toe was replaced with viable tissue and the wound healed completely after 2 weeks of MDT application. This case points out the regenerative effects of MDT besides its mechanical debridement effect on the necrotic tissue.

Binocular portraiture

Pictorial portraits are viewed with two eyes despite the fact that they are mostly monocular: they have been produced from a single viewpoint (either by painters or photographers). The differences between the images on each eye are a consequence of the separation between them rather than differences in two pictorial images. Viewing with two eyes detracts from the monocular cues to depth within the singular portrait because of information for the flatness of the pictorial surface. Binocular portraits, on the other hand, incorporate differences between two pictorial images producing perceptual effects that cannot be seen by a single eye alone. The differences can consist of small disparities that yield stereoscopic depth or large ones that produce binocular rivalry. Binocular portraits require viewing with a stereoscope, many varieties of which exist. Those shown here are anaglyphs which can be observed through red/cyan filters. They are not conventional stereoscopic portraits where the sitter is imaged from two slightly different locations. Rather, the binocular processes of cooperation (stereoscopic depth perception) and competition (binocular rivalry) are manipulated in the binocular portraits. The subjects shown in the anaglyphic portraits have been involved in the science and art of binocular vision.

Preliminary Clinical Evaluation Using a Novel Bioengineered Wound Product to Treat Lower Extremity Ulcers

Diabetes mellitus affects hundreds of millions of people worldwide, each of which have up to a 25% risk of developing a diabetic foot ulcer (DFU) during their lifetime. With poor DFU healing rates using standard of care, advanced treatments are introduced to attempt to close the wound. The objective of this preliminary clinical evaluation was to evaluate lower extremity ulcers treated with a novel bioengineered wound product (BWP). The BWP, a solid absorbable and conformable sheet composed of gelatin, Manuka honey, and hydroxyapatite, was applied on 12 patients with lower extremity ulcers. The patients in this evaluation spanned across 4 sites and had complicated medical histories, including little to no progression of healing with standard of care or treatment with other biomaterials. The ulcers were treated with debridement, BWP placement, dressing, appropriate compression, and offloading as necessary. Weekly follow-up visits were recommended for evaluation, debridement, and BWP reapplication. Nine patients had the BWP applied to aid in full closure. These patients achieved 100% closure within 8 weeks, with a mean closure time of 4.1 weeks. At 4 weeks, the mean percent wound closure was 94%. Three patients had the BWP applied to aid in achieving a healthy wound bed for continued treatment (eg, splitthickness skin graft) and to cover (epithelialization over) an exposed tendon. In all 12 cases, no treatment site infections were observed. The results and observations from this preliminary clinical evaluation suggest that the BWP supports rapid wound closure, a predictor of complete healing for DFUs.

Comparison of Five Camera Systems for Capturing and Grading Trachoma Images

PURPOSE

As training of trachoma graders using live participants grows increasingly difficult and expensive, alternative ways are needed possibly through replacement of field grading with photography. However, minimum specifications for a camera system capable of capturing high quality images have not been defined. This study compared images captured using four smartphones with those from a Nikon SLR camera for image quality and assessment of trachomatous inflammation - follicular (TF).

METHODS

The smartphones - Samsung Galaxy S8 (S8), Techno Camon 17 pro (TC), Infinix Note 10 pro (IN), Huawei p30 pro (HP) - were chosen for their availability and likelihood of good performance based on specifications without external attachments. All smartphones were used in random order for each participant.

RESULTS

129 children in Kongwa, Tanzania were enrolled (32.8% TF prevalence). The SLR camera had the least percent of ungradable images (3.1%), followed by the S8 (14%), HP (23.4%), IN (65.9%), and TC (71.2%). The S8 and the HP were significantly more likely to take ungradable images if they were used toward the end of the camera rotation. Agreement between the SLR and field grade was kappa = 0.73. Agreement between the field grade and gradable images from the S8 (0.68) and HP (0.8) was measured.

CONCLUSIONS

Published specifications did not predict the success of using different smartphones for everted eyelid photographs; proprietary post-processing software likely influenced gradeability. Smartphones, though we cannot recommend those tested in this study, may be viable for capturing images for trachoma provided the quality of images from the field are adequate.

From sneaker to bourgeois male: Long-term observations on recognized tompot blenny Parablennius gattorugine individuals reveal new information on their biology

The behaviour of the tompot blenny Parablennius gattorugine was studied by underwater observation and photography on the south-west coast of the UK over an 11 year period, with >50 individuals identified at two locations by their distinctive skin markings. Observations showed males engaging in rapid swimming behaviour when approached by a female, and younger males using alternative 'sneaker' tactics before becoming 'bourgeois' territory-holders. The noninvasive recognition technique also facilitated detailed observations on territory retention (up to 7 years) and agonistic behaviours among both males and females.

Photographic grading for trachoma diagnosis within trachoma impact surveys in Amhara region, Ethiopia

BACKGROUND

As countries reach the trachoma elimination threshold and cases of trachomatous inflammation follicular (TF) become rare, it becomes difficult to train survey graders to recognize clinical signs. We assess the use of photography as a grading tool, the efficiency of an in-country grading center and the comparability of field and photographic grading.

METHODS

During January-February 2017 surveys in Amhara, Ethiopia, field graders assessed TF, trachomatous inflammation intense (TI) and trachomatous scarring (TS). Photographs were taken from each conjunctiva and later graded at the Gondar Grading Center (GGC) at the University of Gondar in Amhara. Two trained ophthalmology residents graded each set of photographs and a third grader provided an adjudicating grade when needed.

RESULTS

A total of 4953 photographs of 2477 conjunctivae from 1241 participants in 10 communities were graded over 5 d at the GGC. Six examined participants were not photographed. Agreement between field and photographic grades were for TF: percent agreement (PA) 96.7%, κ=0.70 (95% confidence interval [CI] 0.64 to 0.77; for TI: PA 94.7%, κ=0.32 (95% CI 0.20 to 0.43); and for TS: PA 83.5%, κ=0.22 (95% CI 0.15 to 0.29).

CONCLUSIONS

Conjunctival photography may be a solution for programs near the elimination threshold where there are few available community cases for training field graders.

Smartphone Slit Lamp Imaging-Usability and Quality Assessment

PURPOSE

To assess the usability and image quality of a smartphone adapter for direct slit lamp imaging.

METHODS

A single-center, prospective, clinical study conducted in the Department of Ophthalmology at the University Hospital Zurich, Switzerland. The smartphone group consisted of 26 medical staff (consultants, residents, and students). The control group consisted of one ophthalmic photographer. Both groups took images of the anterior and the posterior eye segment of the same proband. The control group used professional photography equipment. The participant group used an Apple iPhone 11 mounted on a slit lamp via a removable SlitREC smartphone adapter (Custom Surgical GmbH, Munich, Germany). The image quality was graded independently by two blinded ophthalmologists on a scale from 0 (low) to 10 (high quality). Images with a score ≥ 7.0/10 were considered as good as the reference images. The acquisition time was measured. A questionnaire on usability and experience in smartphone and slit lamp use was taken by all of the participants.

RESULTS

Each participant had three attempts at the same task. The overall smartphone quality was 7.2/10 for the anterior and 6.4/10 for the posterior segment. The subjectively perceived difficulty decreased significantly over the course of three attempts (Kendall's W). Image quality increased as well but did not improve significantly from take 1 to take 3. However, the image quality of the posterior segment was significantly, positively correlated (Spearman's Rho) with work experience. The mean acquisition time for anterior segment imaging was faster in the smartphone group compared to the control group (156 vs. 206 s). It was vice versa for the posterior segment (180 vs. 151 s).

CONCLUSION

Slit lamp imaging with the presented smartphone adapter provides high-quality imaging of the anterior segment. Posterior segment imaging remains challenging in terms of image quality. The adapter constitutes a cost-effective, portable, easy-to-use solution for recording ophthalmic photos and videos. It can facilitate clinical documentation and communication among colleagues and with the patient especially outside normal consultation hours. Direct slit lamp imaging allows for time to be saved and increases the independence of ophthalmologists in terms of patient mobility and the availability of photographic staff.

The photographers' gaze: the Mobile Radioisotope Exhibition in Latin America (1960-1965)

During the IAEA's Mobile Radioisotope Exhibition (1960-1965) through the eventful roads of five Latin American countries (Mexico, Uruguay, Argentina, Brazil, and Bolivia), a variety of photographs were taken by an unknown Mexican official photographer, and by Josef Obermayer, a staff driver from Vienna. The exhibition carried not only bits of nuclear sciences and technologies, but also the political symbolism of the 'friendly atom' as a token of modernization. The photographs embarked on different trajectories, though all of them ended up at the training and exchange official's desk in charge of the exhibition, Argentinian physicist Arturo Cairo. The ones taken in Mexico also had a local circulation as propaganda intended to promote radioisotope applications. The two sets of images were intended to show the contrast between modernity and traditional society, but they did it from different gazes. Our paper argues that, in the case of Mexico, the photographer reinforced representations of the country which were already popularized by Hollywood for foreign and local audiences. On the other hand, the Viennese photographer's gaze delivers an autoethnography of his dutiful journey. We also argue that Obermayer's projection is one of what Roger Bartra has conceptualized as the 'salvage on the mirror'.

Medicine's Roots: Through the Banyan Trees

Description I started residency before the COVID-19 pandemic, at a time when we were able to see our patient's faces without masks, give reassuring smiles, and sit closely while discussing a difficult diagnosis. Little did I know that in 2019, the way we practice would change overnight, as an unprecedented virus took hold. We could no longer see our patients' faces, reassuring smiles were hidden by masks, and close conversations were held at a distance. Our homes became our claustrophobic havens, and the hospitals were saturated with patients. Driven by a deep-rooted need to assist others, we continued onward. As life shifted toward the new normal, I searched for my own semblance of normalcy, which I found at the Marie Selby Botanical Gardens, where there was beauty that still prevailed, while the world had been in quarantine. On my first visit, I was in awe of the three massive banyan trees adjacent to the main green. Their roots curved over the ground, then delved deeply into the earth. Their branches were so high that the upper leaves were not visible. Staring at the trees, I was reminded of medicine and the COVID-19 pandemic's course. Medicine is a field that began long ago, with its initial roots grounded in the need for patient care. As the field grows and expands, so does the tree-branches off-shooting and new buds forming with each advancement that is spurred. While there may be storms, medicine remains grounded by its roots, while reaching and striving for more. The photograph was taken at the Marie Selby Botanical Gardens, located in Sarasota, FL.

What ugly and beautiful photographs reveal about COVID-19 lockdown experiences, everyday aesthetics and photography aesthetics

Against the backdrop of the COVID-19 pandemic, which restricted our daily (visual) experiences, we asked people to take an ugly and beautiful photograph from within their homes. In total, 284 photographs (142 ugly and 142 beautiful) and accompanying statements were submitted and brought to light an intimate portrait of how participants were experiencing their (lockdown) home environment. Results revealed an aesthetic preference for (living) nature. Beauty and ugliness were also connected to good versus bad views, mess versus cosiness, unflattering versus flattering portraits and positive versus negative (COVID-19) emotions. In terms of photography strategies, editing and colour were important for beautiful photographs, whereas a lack of effort and sharpness showed up relatively more in ugly photographs. A follow-up study revealed that other viewers' (n = 86) aesthetic judgements of the photographs were largely in line with the original submissions, and confirmed several of the themes. Overall, our study provides a unique photographic window on our everyday aesthetic experiences at home during the COVID-19 lockdown.