Comparing the Drop Vertical Jump Tracking Performance of the Azure Kinect to the Kinect V2.

Traditional motion analysis systems are impractical for widespread screening of non-contact anterior cruciate ligament (ACL) injury risk. The Kinect V2 has been identified as a portable and reliable alternative but was replaced by the Azure Kinect. We hypothesize that the Azure Kinect will assess drop vertical jump (DVJ) parameters associated with ACL injury risk with similar accuracy to its predecessor, the Kinect V2. Sixty-nine participants performed DVJs while being recorded by both the Azure Kinect and the Kinect V2 simultaneously. Our software analyzed the data to identify initial coronal, peak coronal, and peak sagittal knee angles. Agreement between the two systems was evaluated using the intraclass correlation coefficient (ICC). There was poor agreement between the Azure Kinect and the Kinect V2 for initial and peak coronal angles (ICC values ranging from 0.135 to 0.446), and moderate agreement for peak sagittal angles (ICC = 0.608, 0.655 for left and right knees, respectively). At this point in time, the Azure Kinect system is not a reliable successor to the Kinect V2 system for assessment of initial coronal, peak coronal, and peak sagittal angles during a DVJ, despite demonstrating superior tracking of continuous knee angles. Alternative motion analysis systems should be explored.

Comparing a Portable Motion Analysis System against the Gold Standard for Potential Anterior Cruciate Ligament Injury Prevention and Screening.

Knee kinematics during a drop vertical jump, measured by the Kinect V2 (Microsoft, Redmond, WA, USA), have been shown to be associated with an increased risk of non-contact anterior cruciate ligament injury. The accuracy and reliability of the Microsoft Kinect V2 has yet to be assessed specifically for tracking the coronal and sagittal knee angles of the drop vertical jump. Eleven participants performed three drop vertical jumps that were recorded using both the Kinect V2 and a gold standard motion analysis system (Vicon, Los Angeles, CA, USA). The initial coronal, peak coronal, and peak sagittal angles of the left and right knees were measured by both systems simultaneously. Analysis of the data obtained by the Kinect V2 was performed by our software. The differences in the mean knee angles measured by the Kinect V2 and the Vicon system were non-significant for all parameters except for the peak sagittal angle of the right leg with a difference of 7.74 degrees and a p-value of 0.008. There was excellent agreement between the Kinect V2 and the Vicon system, with intraclass correlation coefficients consistently over 0.75 for all knee angles measured. Visual analysis revealed a moderate frame-to-frame variability for coronal angles measured by the Kinect V2. The Kinect V2 can be used to capture knee coronal and sagittal angles with sufficient accuracy during a drop vertical jump, suggesting that a Kinect-based portable motion analysis system is suitable to screen individuals for the risk of non-contact anterior cruciate ligament injury.

Using an Affordable Motion Capture System to Evaluate the Prognostic Value of Drop Vertical Jump Parameters for Noncontact ACL Injury.

BACKGROUND: Knee kinematic parameters during a drop vertical jump (DVJ) have been demonstrated to be associated with increased risk of noncontact anterior cruciate ligament (ACL) injury. However, standard motion analysis systems are not practical for routine screening. Affordable and practical motion sensor alternatives exist but require further validation in the context of ACL injury risk assessment. PURPOSE/HYPOTHESIS: To prospectively study DVJ parameters as predictors of noncontact ACL injury in collegiate athletes using an affordable motion capture system (Kinect; Microsoft). We hypothesized that athletes who sustained noncontact ACL injury would have larger initial and peak contact coronal abduction angles and smaller peak flexion angles at the knee during a DVJ. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: 102 participants were prospectively recruited from a collegiate varsity sports program. A total of 101 of the 102 athletes (99%) were followed for an entire season for noncontact ACL injury. Each athlete performed 3 DVJs, and the data were recorded using the motion capture system. Initial coronal, peak coronal, and peak sagittal angles of the knee were identified by our software. RESULTS: Five of the 101 athletes sustained a noncontact ACL injury. Peak coronal angles were significantly greater and peak sagittal flexion angles were significantly smaller in ACL-injured athletes (P = .049, P = .049, respectively). Receiver operating characteristic (ROC) analysis demonstrated an area under the curve of 0.88, 0.92, and 0.90 for initial coronal, peak coronal, and peak sagittal angle, respectively. An initial coronal angle cutoff of 2.96° demonstrated 80% sensitivity and 72% specificity, a peak coronal angle cutoff of 6.16° demonstrated 80% sensitivity and 72% specificity, and a peak sagittal flexion cutoff of 93.82° demonstrated 80% sensitivity and 74% specificity on the study cohort. CONCLUSION: Increased peak coronal angle and decreased peak sagittal angle during a DVJ were significantly associated with increased risk for noncontact ACL injury. Based on ROC analysis, initial coronal angle showed good prognostic ability, whereas peak coronal angle and peak sagittal flexion provided excellent prognostic ability. Affordable motion capture systems show promise as cost-effective and practical options for large-scale ACL injury risk screening.

Impact of a personalised, digital, HIV self-testing app-based program on linkages and new infections in the township populations of South Africa.

INTRODUCTION: Implementation data for digital unsupervised HIV self-testing (HIVST) are sparse. We evaluated the impact of an app-based, personalised, oral HIVST program offered by healthcare workers in Western Cape, South Africa. METHODS: In a quasirandomised study (n=3095), we recruited consenting adults with undiagnosed HIV infection from township clinics. To the HIVST arm participants (n=1535), we offered a choice of an offsite (home, office or kiosk based), unsupervised digital HIVST program (n=962), or an onsite, clinic-based, supervised digital HIVST program (n=573) with 24/7 linkages services.With propensity score analyses, we compared outcomes (ie, linkages, new HIV infections and test referrals) with conventional HIV testing (ConvHT) arm participants (n=1560), recruited randomly from geographically separated clinics. RESULTS: In both arms, participants were young (HIVST vs ConvHT) (mean age: 28.2 years vs 29.2 years), female (65.0% vs 76.0%) and had monthly income <3000 rand (80.8% vs 75%).Participants chose unsupervised HIVST (62.7%) versus supervised HIVST and reported multiple sex partners (10.88% vs 8.7%), exposure to sex workers (1.4% vs 0.2%) and fewer comorbidities (0.9% vs 1.9%). Almost all HIVST participants were linked (unsupervised HIVST (99.7%), supervised HIVST (99.8%) vs ConvHT (98.5%)) (adj RR 1.012; 95% CI 1.005 to 1.018) with new HIV infections: overall HIVST (9%); supervised HIVST (10.9%) and unsupervised HIVST (7.6%) versus ConvHT (6.79%) (adj RR 1.305; 95% CI 1.023 to 1.665); test referrals: 16.7% HIVST versus 3.1% ConvHT (adj RR 5.435; 95% CI 4.024 to 7.340). CONCLUSIONS: Our flexible, personalised, app-based HIVST program, offered by healthcare workers, successfully linked almost all HIV self-testers, detected new infections and increased referrals to self-test. Data are relevant for digital HIVST initiatives worldwide.

Is 0.75 mm Breslow thickness the correct cut-off point for performing sentinel node biopsy in patients with melanoma?

Currently, in patients with malignant melanoma there is no clear cut-off point of Breslow thickness in order to avoid unnecessary lymph node excision surgery, without missing metastatic nodes. We retrospectively studied a cohort of 64 patients, with pathologically proven malignant melanoma, who underwent lymph node scintigraphy and surgical resection of the sentinel node, during the last two years. The patients were divided into 5 groups: Group 1: Ten patients, mean age 46 ± 6 years (range 40-55 years), with Breslow thickness of the lesion 0.51-0.75 mm. Group 2: Eleven patients, mean age 41 ± 9 years (range 31-61 years), with Breslow thickness 0.76-1mm. Group 3: Twelve patients, mean age 59 ± 12 (41-76 years), with Breslow thickness 1.01-1.25 mm. Group 4: Fourteen patients, mean age 61 ± 8 (38-74 years), with Breslow thickness 1.26-1.5mm. Group 5: Seventeen patients, mean age 56 ± 10 (32-71 years), with Breslow thickness >1.5mm. We found only seven infiltrated sentinel lymph nodes. From these, 3 patients belonged to the 5th group (Breslow>1.5mm), two patients to the 4th group (Breslow 1.26-1.5mm), one patient in the 3rd group (Breslow 1.01-1.25 mm) and one patient to the 2nd group (Breslow 0.76-1mm). Since there was no positive sentinel lymph node in any patient with Breslow thickness less than < 0.75 mm, we conclude that sentinel lymph node biopsy in patients with Breslow thickness less than < 0.75 mm may not be useful and might not be carried out, except in high risk cases such as melanomas with ulceration, high mitotic rate and vertical growth phase.

Extracellular vesicles from genetically unstable, oncogene-driven cancer cells trigger micronuclei formation in endothelial cells.

Oncogenic transformation impacts cancer cell interactions with their stroma, including through formation of abnormal blood vessels. This influence is often attributed to angiogenic growth factors, either soluble, or associated with tumor cell-derived extracellular vesicles (EVs). Here we examine some of the cancer-specific components of EV-mediated tumor-vascular interactions, including the impact of genetic driver mutations and genetic instability. Cancer cells expressing mutant HRAS oncogene exhibit aberrations of chromatin architecture, aneuploidy, cytoplasmic chromatin deposition and formation of micronuclei with a non-random chromosome content. EVs released from such HRAS-driven cells carry genomic DNA, including oncogenic sequences, and transfer this material to endothelial cells while inducing abnormal formation of micronuclei, along with cell migration and proliferation. Micronuclei were also triggered following treatment with EVs derived from glioma cells (and stem cells) expressing EGFRvIII oncogene, and in both endothelial cells and astrocytes. EVs from HRAS and EGFRvIII-driven cancer cells carry 19 common proteins while EVs from indolent control cells exhibit more divergent proteomes. Immortalized endothelial cell lines with disrupted TP53 pathway were refractory to EV-mediated micronuclei induction. We suggest that oncogenic transformation and intercellular trafficking of cancer-derived EVs may contribute to pathological vascular responses in cancer due to intercellular transmission of genomic instability.

Which community-based HIV initiatives are effective in achieving UNAIDS 90-90-90 targets? A systematic review and meta-analysis of evidence (2007-2018).

BACKGROUND: Reaching the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets to end the HIV epidemic relies on effective interventions that engage untested HIV+ individuals and retain them in care. Evidence on community-based interventions through the lens of the targets has not yet been synthesized, reflecting a knowledge gap. We conducted a systematic review and meta-analysis to shed light on successful community-based interventions that have been effective in contributing, directly or indirectly, towards the UNAIDS 90-90-90 targets: knowledge of HIV status, linkage to care/on treatment, and viral suppression. Linkage to care was also included in this review due to the limitations of studies. METHODS: We conducted a systematic review and meta-analysis of the period 2007-2018. Eleven databases were searched to identify community-based interventions designed to improve knowledge of HIV status (in particular HIV testing), linkage to care/on treatment, and/or viral suppression. Eligible studies were classified by intervention, population, country income level, outcomes and success. Success was defined as interventions demonstrating statistical significance between intervention and control group or that reached any target by proportion; 90% testing, 81% linked to care/on treatment and 73% viral suppression. RESULTS: Of 82 eligible studies, 51.2% (42/82) reported on HIV testing (first 90), 20.7% (17/82) on linkage to care/ on treatment (second 90), and 45.1% (37/82) on viral suppression (third 90). In all, 67.1% (55/82) of studies reported success; 21 studies on the first 90, 9 towards linkage to care/on treatment, and 25 towards the third. By strategies, 36.6% deployed community workers/peers, 22% used combined test and treat strategies, 12.2% used educational methods, 8.5% used mobile testing, 7.3% used campaigns and 13.4% used technology. For HIV testing/linkage, combined test/treat interventions were often used, for viral suppression, educational interventions and technologies were commonly deployed. Our pooled analysis suggested that deployment of community health care workers/peer workers significantly improved viral suppression (pooled OR: 1.40 95% CI 1.06-1.86). Of the studies published after 2014, 50.0% reported metrics aligned with UNAIDS targets. CONCLUSIONS: Data on linkage to care/on treatment (second target) remained weak, because many studies reported successes on the first and third targets. Stratification by targets and country income levels is informative and guides adaptation of successful interventions in comparable settings. Consistent reporting of clear metrics aligned with UNAIDS targets will aid in synergy of study data with programmatic data that will help reportage. Exploration of innovative interventions, for engagement and linkage and deployment of community/ peer workers is strongly encouraged.

Are policy initiatives aligned to meet UNAIDS 90-90-90 targets impacting HIV testing and linkages to care? Evidence from a systematic review.

BACKGROUND: The Joint United Nations Programme on HIV/AIDS (UNAIDS) Fast-Track initiative seeks to eliminate AIDS as a health threat by 2030, with its focus on UNAIDS 90-90-90 targets. Effective policies and programs, if scaled nationally, have the potential to generate a greater impact on HIV control, yet a synthesis of successful HIV policies/programs aligned to the targets is currently unavailable. To fill this gap, we conducted a systematic review to evaluate successful HIV policies and programs to direct future interventions. METHODS: For the period 2007-2018, we searched 8 databases and classified eligible studies by country income level, UNAIDS targets, intervention type, and reported outcomes. Study outcomes were classified as per UNAIDS targets; proportionally: 90% target 1, 81% target 2, and 73% target 3. RESULTS: We retrieved 5201 citations and a final set of eight studies on policies. Break up by income: three (38%) from high income, one (12%) from middle income and four (50%) from low income. Break up by outcomes reported: 36% (4/11) focused on HIV testing, 46% (5/11) on antiretroviral therapy initiation, and 18% (2/11) on viral suppression. Across studies, UNAIDS targets were met in high-income countries, where policies and guidelines were adhered to, whereas in low and middle-income countries, non-adherence led to failure to reach the targets. Targets were also met when country infrastructure supported a targeted program and stakeholders were actively engaged. CONCLUSIONS: From the studies identified, we deduced a clear, positive correlation between implementation of policies and programs that resulted in an increase in patient awareness and an increase in partner notification with services that encouraged them, and together these resulted in increasing testing rates, and deployment of linkage/retention programs that improved retention in care. An analysis of these studies also suggests that policies, combined with the scale-up incentives, are needed to change the status quo. Incentives to improve the targets must exist; performance incentives at the health care worker level and country level incentives that could transform the nature of care. Given the complexity in reporting of targets, a one size fits all model is not a feasible option. However, the policies created a strong framework to shape future interventions.

Measures and Metrics for Feasibility of Proof-of-Concept Studies With Human Immunodeficiency Virus Rapid Point-of-Care Technologies: The Evidence and the Framework.

OBJECTIVE: Pilot (feasibility) studies form a vast majority of diagnostic studies with point-of-care technologies but often lack use of clear measures/metrics and a consistent framework for reporting and evaluation. To fill this gap, we systematically reviewed data to (a) catalog feasibility measures/metrics and (b) propose a framework. METHODS: For the period January 2000 to March 2014, 2 reviewers searched 4 databases (MEDLINE, EMBASE, CINAHL, Scopus), retrieved 1441 citations, and abstracted data from 81 studies. We observed 2 major categories of measures, that is, implementation centered and patient centered, and 4 subcategories of measures, that is, feasibility, acceptability, preference, and patient experience. We defined and delineated metrics and measures for a feasibility framework. We documented impact measures for a comparison. FINDINGS: We observed heterogeneity in reporting of metrics as well as misclassification and misuse of metrics within measures. Although we observed poorly defined measures and metrics for feasibility, preference, and patient experience, in contrast, acceptability measure was the best defined. For example, within feasibility, metrics such as consent, completion, new infection, linkage rates, and turnaround times were misclassified and reported. Similarly, patient experience was variously reported as test convenience, comfort, pain, and/or satisfaction. In contrast, within impact measures, all the metrics were well documented, thus serving as a good baseline comparator. With our framework, we classified, delineated, and defined quantitative measures and metrics for feasibility. CONCLUSIONS: Our framework, with its defined measures/metrics, could reduce misclassification and improve the overall quality of reporting for monitoring and evaluation of rapid point-of-care technology strategies and their context-driven optimization.