Familiarization with Mixed Reality for Individuals with Autism Spectrum Disorder: An Eye Tracking Study

Mixed Reality (MR) technology is experiencing significant growth in the industrial and healthcare sectors. The headset HoloLens 2 displays virtual objects (in the form of holograms) in the user's environment in real-time. Individuals with Autism Spectrum Disorder (ASD) exhibit, according to the DSM-5, persistent deficits in communication and social interaction, as well as a different sensitivity compared to neurotypical (NT) individuals. This study aims to propose a method for familiarizing eleven individuals with severe ASD with the HoloLens 2 headset and the use of MR technology through a tutorial. The secondary objective is to obtain quantitative learning indicators in MR, such as execution speed and eye tracking (ET), by comparing individuals with ASD to neurotypical individuals. We observed that 81.81% of individuals with ASD successfully familiarized themselves with MR after several sessions. Furthermore, the visual activity of individuals with ASD did not differ from that of neurotypical individuals when they successfully familiarized themselves. This study thus offers new perspectives on skill acquisition indicators useful for supporting neurodevelopmental disorders. It contributes to a better understanding of the neural mechanisms underlying learning in MR for individuals with ASD.

Computer-Aided Screening of Autism Spectrum Disorder: Eye-Tracking Study Using Data Visualization and Deep Learning

Background

The early diagnosis of autism spectrum disorder (ASD) is highly desirable but remains a challenging task, which requires a set of cognitive tests and hours of clinical examinations. In addition, variations of such symptoms exist, which can make the identification of ASD even more difficult. Although diagnosis tests are largely developed by experts, they are still subject to human bias. In this respect, computer-assisted technologies can play a key role in supporting the screening process.

Objective

This paper follows on the path of using eye tracking as an integrated part of screening assessment in ASD based on the characteristic elements of the eye gaze. This study adds to the mounting efforts in using eye tracking technology to support the process of ASD screening

Methods

The proposed approach basically aims to integrate eye tracking with visualization and machine learning. A group of 59 school-aged participants took part in the study. The participants were invited to watch a set of age-appropriate photographs and videos related to social cognition. Initially, eye-tracking scanpaths were transformed into a visual representation as a set of images. Subsequently, a convolutional neural network was trained to perform the image classification task.

Results

The experimental results demonstrated that the visual representation could simplify the diagnostic task and also attained high accuracy. Specifically, the convolutional neural network model could achieve a promising classification accuracy. This largely suggests that visualizations could successfully encode the information of gaze motion and its underlying dynamics. Further, we explored possible correlations between the autism severity and the dynamics of eye movement based on the maximal information coefficient. The findings primarily show that the combination of eye tracking, visualization, and machine learning have strong potential in developing an objective tool to assist in the screening of ASD.

Conclusions

Broadly speaking, the approach we propose could be transferable to screening for other disorders, particularly neurodevelopmental disorders.

Motivation to pursue anti-TNFα treatment in patients with Crohn's disease - the SPACE motivation study

BACKGROUND

Crohn's disease (CD) is a chronic disorder requiring long-term treatment. However, up to 20% of patients interrupt temporarily or permanently anti-TNFα. Primary aim was to identify internal and external factors influencing patient's motivation to pursue anti-TNFα in active CD.

METHODS

This was a French, multicentre, prospective study enrolling CD patients on anti-TNFα therapy since more than 3 months. Patients completed the Satisfaction of Patients with Crohn's Disease questionnaire (SPACE-Q) and other patient-reported-outcome tools at inclusion visit, and after 6 and 12 months.

RESULTS

A total of 274 patients were included: 146 (53.3%) received adalimumab, while 128 (46.7%) infliximab. Most patients (78%) were still treated with anti-TNFα 12 months after enrolment. Patients' perception of necessity (p = 0.01) and concerns (p<0.0001) regarding medication, evaluated through the Belief about Medicines Questionnaire (BMQ), and expectation confirmation towards treatment convenience (p = 0.02), towards efficacy (p = 0.04), and treatment satisfaction (p = 0.03) according to SPACE-Q, correlated with motivation to pursue treatment. Patients with higher treatment satisfaction (p = 0.0004), stronger belief in treatment necessity (p<0.0001) and fewer concerns (p = 0.0002) were more likely to be very motivated.

CONCLUSION

Treatment satisfaction, treatment necessity, and concerns are correlated to motivation to pursue anti-TNFα. Specific questions focused on these patients' perceptions could help physicians to identify patients at risk of non-adherence and prevent therapy interruption.

Visual Exploration of Dynamic or Static Joint Attention Bids in Children With Autism Syndrome Disorder

Eye-tracking studies have revealed a specific visual exploration style characterizing individuals with autism spectrum disorder (ASD). The aim of this study is to investigate the impact of stimulus type (static vs. dynamic) on visual exploration in children with ASD. Twenty-eight children with ASD, 28 children matched for developmental communication age, and 28 children matched for chronological age watched a video and a series of photos involving the same joint attention scene. For each stimulus, areas of interest (AOI) were determined based on Voronoi diagrams, which were defined around participants' fixation densities, defined by the mean shift algorithm. To analyze the eye-tracking data on visual exploration, we used a method for creating AOI a posteriori, based on participants' actual fixations. The results showed the value of both kinds of stimuli. The photos allowed for the identification of more precise AOI and showed similarities in exploration between ASD and typical children. On the other hand, video revealed that, among ASD children only, there are few differences in the way they look at the target depending on the deictic cue used. This raises questions regarding their understanding of a joint attention bid recorded on a video. Finally, whatever the stimulus, pointing seems to be the most important element for children looking at the target.

Measuring patients' satisfaction with their anti-TNF treatment in severe Crohn's disease: scoring and psychometric validation of the Satisfaction for PAtients in Crohn's diseasE Questionnaire (SPACE-Q(©))

BACKGROUND

Severe Crohn's disease management includes anti-tumor necrosis factor (anti-TNF) drugs that differ from early-stage treatments regarding efficacy, safety, and convenience. This study aimed to finalize and psychometrically validate the Satisfaction for PAtients in Crohn's diseasE Questionnaire (SPACE-Q(©)), developed to measure satisfaction with anti-TNF treatment in patients with severe Crohn's disease.

METHODS

A total of 279 patients with severe Crohn's disease receiving anti-TNF therapy completed the SPACE-Q 62-item pilot version at inclusion and 12 and 13 weeks after first anti-TNF injection. The final SPACE-Q scoring was defined using multitrait and regression analyses and clinical relevance considerations. Psychometric validation included clinical validity against Harvey-Bradshaw score, concurrent validity against Treatment Satisfaction Questionnaire for Medication (TSQM), internal consistency reliability, test-retest reliability, and responsiveness against the patient global impression of change (PGIC).

RESULTS

Quality of completion was good (55%-67% of patients completed all items). Four items were removed from the questionnaire. Eleven scores were defined within the final 58-item SPACE-Q: disease control; symptoms, anal symptoms, and quality of life transition scales; tolerability; convenience; expectation confirmation toward efficacy, side effects, and convenience; satisfaction with treatment; and motivation. Scores met standards for concurrent validity (correlation between SPACE-Q satisfaction with treatment and TSQM satisfaction scores =0.59), internal consistency reliability (Cronbach's α=0.67-0.93), test-retest reliability (intraclass correlations =0.62-0.91), and responsiveness (improvement in treatment experience assessed by the SPACE-Q for patients reporting improvement on the PGIC). Significantly different mean scores were observed between groups of patients with different Harvey-Bradshaw disease severity scores.

CONCLUSION

The SPACE-Q is a valid, reliable, and responsive instrument to measure satisfaction with anti-TNF treatment in patients with severe Crohn's disease and for use in future studies.

The impact of verbal capacity on theory of mind in deaf and hard of hearing children

Even when they have good language skills, many children with hearing loss lag several years behind hearing children in the ability to grasp beliefs of others. The researchers sought to determine whether this lag results from difficulty with the verbal demands of tasks or from conceptual delays. The researchers related children's performance on a nonverbal theory of mind task to their scores on verbal aptitude tests. Twelve French children (average age about 10 years) with severe to profound hearing loss and 12 French hearing children (average about 7 years) were evaluated. The children with hearing loss showed persistent difficulty with theory of mind tasks, even a nonverbal task, presenting results similar to those of hearing 6-year-olds. Also, the children with hearing loss showed a correlation between language level (lexical and morphosyntactic) and understanding of false beliefs. No such correlation was found in the hearing children.

Assessing patients' satisfaction with anti-TNFα treatment in Crohn's disease: qualitative steps of the development of a new questionnaire

PURPOSE

To develop a self-administered questionnaire assessing patients' satisfaction with treatments in Crohn's disease for use in clinical research and epidemiological studies.

PATIENTS AND METHODS

Semi-directive interviews (16) were conducted with patients with severe Crohn's disease treated with anti-tumor necrosis factor alpha (anti-TNFα). Transcripts were analyzed and concepts related to satisfaction with treatment were extracted and organized into a model. Items were generated using patients' words. The resulting test version was tested for relevance and comprehension with 7 patients and revised accordingly; the new version was tested with 5 other patients and revised to provide the pilot version. A clinician advisory board was involved at each milestone of the development.

RESULTS

The test questionnaire assessed treatment satisfaction through 67 items, organized into 5 sections: treatment efficacy, side-effects, convenience and constraints, overall impact, and satisfaction. Conceptual content of the questionnaire includes comparison with prior state and with expectations, satisfaction, acceptability, and intentions. The questionnaire was generally well accepted and understood by patients; few modifications were made in the structure and item formulation. After the second round of comprehension tests, the pilot version contained 62 items; the questionnaire was named Satisfaction of PAtients in Crohn's diseasE (SPACE(©)).

CONCLUSION

The questionnaire is a unique tool to assess treatment satisfaction in patients with Crohn's disease. A scoring and validation study is currently being performed to finalize and establish its scoring, as well as its psychometric properties.

Early hearing screening: what is the best strategy?

OBJECTIVES

A discussion concerning the relevance of universal newborn hearing screening has been conducted in France since the end of the 1990s. As a contribution to the choice of strategy to be implemented, we evaluated and compared the results of this screening and its impact on the parent-infant relationship as a function of the time at which screening was performed: during the infant's stay in the maternity unit, in the first strategy (strategy 1), or 2 months after birth, in the second strategy (strategy 2).

PATIENTS AND METHOD

Five thousand seven hundred and ninety infants participated in the study: 3202 were included in the first strategy and 2588 were included in the second strategy. Within this population, 143 mother-infant pairs were submitted to psychological assessment. We compared the number of infants screened, the number of first positive tests, the number of false-positive tests and the number of infants not reviewed after screening. Adverse effects on the parent-infant relationship were evaluated in terms of maternal anxiety and the quality of early interactions.

RESULTS

A statistically significant difference in favor of newborn screening was demonstrated for the number of infants screened: 95.72% for the first strategy [95.0%; 96.4%], 64.18% for the second strategy [62.3%; 66.0%]; the number of first positive tests: 1.11% during newborn screening [0.7%; 1.5%], 3.13% in the second strategy [2.3%; 4.0%]; the number of false-positive tests: 0.29% in the first strategy [0.10%; 0.49%] and 2.65% in the second strategy [1.88%; 3.42%]; and the number of infants not reviewed after screening: 8.8% during newborn screening [0.0%; 18.4%] and 38.5% in the second strategy [25.2%; 51.7%]. Analysis of the results of the psychological assessment showed that screening per se did not have any impact on maternal anxiety or on the quality of early interactions, regardless of the screening strategy used. However, the result of the test had a significant impact. Announcement of a positive result increased maternal anxiety and induced a deterioration of the mother's psychological state which affected the quality of early interactions. As the number of positive results is significantly lower in newborn hearing screening, there are consequently fewer psychological side effects with this strategy than with the second strategy.

CONCLUSION

This study demonstrates that universal newborn hearing screening is the most efficient strategy.

Complementary and alternative medicine use by patients with inflammatory bowel disease: results from a postal survey

AIMS

Thirty to 50% of north American patients with inflammatory bowel disease (IBD) have been reported to use complementary and alternative medicine (CAM). There is no data in France. The aim of this study was to evaluate the frequency of CAM use and the reasons in a French population of patients with IBD.

PATIENTS AND METHODS

An anonymous postal survey was done with a questionnaire mailed to all the patients with IBD, 16 to 79 year-old, followed-up in a public and a private medical centre of Reims, between January 2001 and December 2003.

RESULTS

The final sample included 447 patients; 325 (72.7%) filled up the questionnaire: 219 (67.4%) had Crohn's disease, 94 (28.8%) ulcerative colitis and 12 (3.7%) indeterminate colitis. Sixty-nine patients (21.2%) reported CAM use for IBD. The mean number of CAM used simultaneously was 2.9. The most frequently used CAM treatment was homeopathy (40.6%), followed by magnetism (34.8%) and acupuncture (33.3%). The majority of patients (74.8%) never talked about CAM use with their IBD physician. Multivariate analysis showed that the factors significantly associated with CAM use were female gender (odds ratio (OR)=3.5, CI95%: 1.8-6.9), the low level of confidence in their doctor (OR=4.8, CI95%: 1.1-19.8) and the research of informations about their disease (OR=4.6, CI 95%: 2.0-10.7).

CONCLUSION

Twenty-one percent of patients with IBD are using CAM, most of the time without talking about it with their physician. The quality of the relationship between the patient and his physician and female sex, more than the perceived severity of the disease, were the main determinants of that use.

[Protective effect of appendectomy on the development of ulcerative colitis. A case-control study]

AIMS

To examine by a case-control study the relationship between appendectomy and subsequent ulcerative colitis development in a French population.

METHODS

A total of 150 patients with ulcerative colitis were matched for age (+/- 5 years) and sex, with 150 controls recruited in a preventive medicine center. The following data were collected from medical records and by standardised questionnaire in consultation or by phone: appendectomy and tonsillectomy before the onset of ulcerative colitis, smoking habits and area of residence.

RESULTS

The rate of previous appendectomy in patients with ulcerative colitis was 8% (12/150) compared with 30.6% (46/150) in the control group (P=0.001). There was no significant association between ulcerative colitis and tonsillectomy (25.3 and 27.3% in the control and the ulcerative colitis groups, respectively). Smoking was more frequent in the control group (36%) than in the ulcerative colitis group (25.3%) but the difference was not significant (P=0.07). In multivariate analysis, the risk of developing ulcerative colitis was significantly lower after previous appendectomy (odds ratio=0.26; 95% confidence interval: 0.13-0.55; P=7 x 10(-4)).

CONCLUSION

Our study confirms the inverse association between appendectomy and subsequent ulcerative colitis, in a French population, after adjusting on smoking.

[Evaluation by endoscopic biopsies, of the histological criteria of reflux esophagitis]

Histologic criteria of esophagitis and/or gastroesophageal reflux have been described in suction biopsy specimens which are easy to orient for perpendicular section of the mucosal surface. The aim of this study was to reassess the currently accepted criteria in guided endoscopic pinch biopsy specimens obtained from esophageal erosions. Epithelium of each sample was stained by Lugol's solution in order to be able to spread the specimen out flat and orient it before fixation. Of 92 biopsies nine were composed of granulation tissue and were excluded from the study. Of the remaining 83 biopsy specimens, 74 (89.2 p. 100) from 66 patients were properly oriented. Of these 74.65 (87.8 p. 100) from 57 patients contained lamina propria. Combination of the 2 epithelial criteria, i.e. papillary height and basal cell zone thickness greater than 50 p. 100 and 14 p. 100 of total epithelial thickness, respectively, were recorded in only 58 p. 100 of 66 patients. Nevertheless, the mean papillary height and the mean basal cell layer thickness were 64 p. 100 and 19 p. 100 of total epithelial thickness, respectively. Infiltration of the lamina propria by neutrophilic and/or eosinophilic granulocytes were recorded in 32 of 57 patients (56 p. 100) and only in 48 p. 100 of biopsy specimens which did not display any epithelial defect. Combination of pathologic changes in epithelium and lamina propria were observed in only 32 p. 100 of the patients and were not more frequent than expected on the basis of a chance association. We conclude that histologic criteria have a low sensitivity even in patients with erosive esophagitis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Carcinoembryonic antigen in ascites and pleural effusions]

The purpose of this prospective study was to evaluate the usefulness of carcinoembryonic antigen (CEA) assays in effusion fluids for the diagnosis of cancer. From 1978 to 1981, 63 patients totaling 67 effusions were investigated for malignant cells and CEA concentrations. There were 62 cases of ascites and 5 cases of pleural effusion resulting from 35 cirrhoses and 28 cancers, including 17 adenocarcinomas. Macroscopic examination of serous membranes was possible in 24 patients. CEA concentrations at least 4 times higher than the upper limit of normal laboratory values were required to diagnose malignancy in effusions. The specificity of both cytology and CEA assays was 100 p. 100 in cirrhotic ascites. Malignant cells were present in 14 cases and positive CEA levels in 19 cases. CEA concentrations were highly significant (p less than 0.001) of cancerous effusions due to adenocarcinomas. In cancers other than adenocarcinoma and in hepatocarcinoma, CEA assays did not prove useful, and cytological examination remained the best diagnostic method. Both cytology and CEA levels were positive for malignancy in 11 effusions, and a diagnosis of cancer could be made on these grounds in 22 out 28 cases. Lack of correlation between CEA concentrations in sera and in effusion fluids suggests local production consecutive to invasion of the serous membranes. All 8 adenocarcinoma patients with grossly detectable extension to the peritoneum had high CEA concentrations, but malignant cells were absent in 4 cases. This discrepancy might tentatively be explained by local dissemination via the lymphatic system without disruption of the membrane but resulting in reflux of CEA into the effusion fluid.(ABSTRACT TRUNCATED AT 250 WORDS)