End-to-end physics-informed deep neural network optimization of sub-Nyquist lenses.

In this paper, an approach for optimizing sub-Nyquist lenses using an end-to-end physics-informed deep neural network is presented. The simulation and optimization of these sub-Nyquist lenses is investigated for image quality, classification performance, or both. This approach integrates a diffractive optical model with a deep learning classifier, forming a unified optimization framework that facilitates simultaneous simulation and optimization. Lenses in this work span numerical apertures from approximately 0.1 to 1.0, and a total of 707 models are trained using the PyTorch-Lightning deep learning framework. Results demonstrate that the optimized lenses produce better image quality in terms of mean squared error (MSE) compared to analytical lenses by reducing the impact of diffraction order aliasing. When combined with the classifier, the optimized lenses show improved classification performance and reduced variability across the focal range. Additionally, the absence of correlation between the MSE measurement of image quality and classification performance suggests that images that appear good according to the MSE metric may not necessarily be beneficial for the classifier.

Linguistic Explanations of Black Box Deep Learning Detectors on Simulated Aerial Drone Imagery.

Deep learning has become increasingly common in aerial imagery analysis. As its use continues to grow, it is crucial that we understand and can explain its behavior. One eXplainable AI (XAI) approach is to generate linguistic summarizations of data and/or models. However, the number of summaries can increase significantly with the number of data attributes, posing a challenge. Herein, we proposed a hierarchical approach for generating and evaluating linguistic statements of black box deep learning models. Our approach scores and ranks statements according to user-specified criteria. A systematic process was outlined for the evaluation of an object detector on a low altitude aerial drone. A deep learning model trained on real imagery was evaluated on a photorealistic simulated dataset with known ground truth across different contexts. The effectiveness and versatility of our approach was demonstrated by showing tailored linguistic summaries for different user types. Ultimately, this process is an efficient human-centric way of identifying successes, shortcomings, and biases in data and deep learning models.

A Case of Oxalate Nephropathy Associated With Prolonged Cholecystostomy Tube Placement.

Oxalate nephropathy is a rare pathology that can be difficult to diagnose. It results from calcium oxalate crystals that are deposited in the renal interstitium or renal tubules. Once the deposition ensues, a multitude of complications can occur, including renal failure. One etiology for oxalate nephropathy is a lack of biliary acid. The diagnosis of oxalate nephropathy is typically based on visualization of oxalate crystals in the renal tubules on biopsy, and treatment based on the etiology can range from simple removal of the offending agent or a change in diet to liver/kidney transplant in the setting of primary hyperoxaluria. This report discusses a case of severe oxalate nephropathy related to long-term cholecystostomy tube placement resulting in a deficiency of biliary acid.

Combining Procedural and Behavioral Treatments for Chronic Low Back Pain: A Pilot Feasibility Randomized Controlled Trial.

Individual treatments for chronic low back pain (CLBP) have small magnitude effects. Combining different types of treatments may produce larger effects. This study used a 2×2 factorial randomized controlled trial (RCT) design to combine procedural and behavioral treatments for CLBP. The study aims were to: (1) assess feasibility of conducting a factorial RCT of these treatments; and (2) estimate individual and combined treatment effects of (a) lumbar radiofrequency ablation (LRFA) of the dorsal ramus medial branch nerves (vs. a simulated LRFA control procedure) and (b) Activity Tracker-Informed Video-Enabled Cognitive Behavioral Therapy program for CLBP (AcTIVE-CBT) (vs. an educational control treatment) on back-related disability at 3 months post-randomization. Participants (n=13) were randomized in a 1:1:1:1 ratio. Feasibility goals included an enrollment proportion ≥30%, a randomization proportion ≥80%, and a ≥80% proportion of randomized participants completing the 3-month Roland-Morris Disability Questionnaire (RMDQ) primary outcome endpoint. An intent-to-treat analysis was used. The enrollment proportion was 62%, the randomization proportion was 81%, and all randomized participants completed the primary outcome. Though not statistically significant, there was a beneficial, moderate-magnitude effect of LRFA vs. control on 3-month RMDQ (-3.25 RMDQ points; 95% CI: -10.18, 3.67). There was a significant, beneficial, large-magnitude effect of AcTIVECBT vs. control (-6.29, 95% CI: -10.97, -1.60). Though not statistically significant, there was a beneficial, large effect of LRFA+AcTIVE-CBT vs. control (-8.37; 95% CI: -21.47, 4.74). We conclude that it is feasible to conduct an RCT combining procedural and behavioral treatments for CLBP.

Association Between Patient Factors and the Effectiveness of Wearable Trackers at Increasing the Number of Steps per Day Among Adults With Cardiometabolic Conditions: Meta-analysis of Individual Patient Data From Randomized Controlled Trials.

BACKGROUND: Current evidence supports the use of wearable trackers by people with cardiometabolic conditions. However, as the health benefits are small and confounded by heterogeneity, there remains uncertainty as to which patient groups are most helped by wearable trackers. OBJECTIVE: This study examined the effects of wearable trackers in patients with cardiometabolic conditions to identify subgroups of patients who most benefited and to understand interventional differences. METHODS: We obtained individual participant data from randomized controlled trials of wearable trackers that were conducted before December 2020 and measured steps per day as the primary outcome in participants with cardiometabolic conditions including diabetes, overweight or obesity, and cardiovascular disease. We used statistical models to account for clustering of participants within trials and heterogeneity across trials to estimate mean differences with the 95% CI. RESULTS: Individual participant data were obtained from 9 of 25 eligible randomized controlled trials, which included 1481 of 3178 (47%) total participants. The wearable trackers revealed that over the median duration of 12 weeks, steps per day increased by 1656 (95% CI 918-2395), a significant change. Greater increases in steps per day from interventions using wearable trackers were observed in men (interaction coefficient -668, 95% CI -1157 to -180), patients in age categories over 50 years (50-59 years: interaction coefficient 1175, 95% CI 377-1973; 60-69 years: interaction coefficient 981, 95% CI 222-1740; 70-90 years: interaction coefficient 1060, 95% CI 200-1920), White patients (interaction coefficient 995, 95% CI 360-1631), and patients with fewer comorbidities (interaction coefficient -517, 95% CI -1188 to -11) compared to women, those aged below 50, non-White patients, and patients with multimorbidity. In terms of interventional differences, only face-to-face delivery of the tracker impacted the effectiveness of the interventions by increasing steps per day. CONCLUSIONS: In patients with cardiometabolic conditions, interventions using wearable trackers to improve steps per day mostly benefited older White men without multimorbidity. TRIAL REGISTRATION: PROSPERO CRD42019143012; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=143012.

Coordination of Care Between Chiropractic and Behavioral Health Practitioners Within the US Department of Veterans Affairs Health Care System: A Report of 3 Patients With Pain and Mental Health Symptoms.

Objective: The purpose of this case series is to describe coordination of care between chiropractic and behavioral health practitioners within an integrated hospital-based system. Clinical Features: Three individuals presented to a US Veterans Affairs Health Care system with musculoskeletal complaints for chiropractic care. Each person demonstrated symptoms of depression or anxiety and in 2 cases indicated passive suicidal ideation. Intervention and Outcome: The chiropractors referred the patients to a mental health provider for co-management. Different approaches to mental health care were offered to each of these patients to meet their individual preferences and needs as part of an evidence informed approach. One patient underwent individual cognitive behavioral therapy; 1 patient responded well to individual cognitive behavioral therapy before transitioning to group-based pain skills, resiliency, and mindfulness therapy; and 1 patient required additional referral to Primary Care-Mental Health Integration for pharmacologic treatment. The 3 patients responded positively to interdisciplinary care and realized functional improvements and improved patient reported outcomes as assessed with the 11-point Numerical Pain Rating Scale and Neck or Back Bournemouth Questionnaire. Conclusion: This case series describes the recognition of mental health symptoms, referral to behavioral health providers, and the subsequent treatment approaches. This case series presents the first description of co-managed care for US veterans by a chiropractor and psychologist.

Best Practices for Chiropractic Management of Adult Patients With Mechanical Low Back Pain: A Clinical Practice Guideline for Chiropractors in the United States.

OBJECTIVE: The purpose of this paper was to update the previously published 2016 best-practice recommendations for chiropractic management of adults with mechanical low back pain (LBP) in the United States. METHODS: Two experienced health librarians conducted the literature searches for clinical practice guidelines and other relevant literature, and the investigators performed quality assessment of included studies. PubMed was searched from March 2015 to September 2021. A steering committee of 10 experts in chiropractic research, education, and practice used the most current relevant guidelines and publications to update care recommendations. A panel of 69 experts used a modified Delphi process to rate the recommendations. RESULTS: The literature search yielded 14 clinical practice guidelines, 10 systematic reviews, and 5 randomized controlled trials (all high quality). Sixty-nine members of the panel rated 38 recommendations. All but 1 statement achieved consensus in the first round, and the final statement reached consensus in the second round. Recommendations covered the clinical encounter from history, physical examination, and diagnostic considerations through informed consent, co-management, and treatment considerations for patients with mechanical LBP. CONCLUSION: This paper updates a previously published best-practice document for chiropractic management of adults with mechanical LBP.

The chiropractor's role in primary, secondary, and tertiary prevention of suicide: a clinical guide.

OBJECTIVE: To provide the practicing chiropractor foundational knowledge to enhance the understanding of relevant primary, secondary, and tertiary public health measures for suicide prevention. METHODS: A descriptive literature review was performed using keywords low back pain, neck pain, psychosocial, pain, public health, suicide, suicide risk factors, and suicide prevention. English language articles pertaining to suicide prevention and the chiropractic profession were retrieved and evaluated for relevance. Additional documents from the Centers for Disease Control, Veterans Health Administration, and the World Health Organization were reviewed. Key literature from the clinical social work and clinical psychology fields were provided by authorship team subject matter experts. CONCLUSION: No articles reported a position statement regarding suicide prevention specific to the chiropractic profession. Risk, modifiable, and protective factors associated with self-directed violence are important clinical considerations. A proactive approach to managing patients at-risk includes developing interprofessional and collaborative relationships with mental health care professionals.

OBJECTIF: Donner aux chiropraticiens en exercice les connaissances de base nécessaires pour leur permettre de mieux saisir les mesures de santé publique primaires, secondaires et tertiaires servant à prévenir le suicide. MÉTHODOLOGIE: On a fait une revue descriptive de la littérature à l'aide des mots-clés suivants : lombalgie, cervicalgie, psychosocial, douleur, santé publique, suicide, facteurs de risque de suicide et prévention du suicide. On a évalué la pertinence des articles en anglais portant sur la prévention du suicide et la profession de chiropraticien. On a examiné d'autres documents provenant de Centers for Disease Control, de la Veterans Health Administration et de l'Organisation mondiale de la santé. Des experts en la matière, membres du comité de rédaction, ont fourni des articles importants sur le travail social clinique et la psychologie clinique. CONCLUSION: Aucun article ne renferme d'énoncé de principe sur la prévention du suicide issu de professionnels de la chiropratique. Les facteurs de risque, les facteurs modifiables et les facteurs de protection associés à l'automutilation sont des aspects importants à examiner. La prise en charge des patients vulnérables d'une manière proactive consiste entre autres à établir et à entretenir des liens de collaboration avec les professionnels de la santé mentale.

Post-fabrication tuning of microring resonators using 3D-printed microfluidics.

We demonstrate a method of tuning the resonant frequencies of silicon microring resonators using a 3D-printed microfluidic chip overlaid directly on the photonic circuit with zero energy consumption following the initial tuning. Aqueous solutions with different concentrations of NaCl are used in experimentation. A shift of a full free spectral range is observed at a concentration of 10% NaCl. On a 60 µm microring resonator, this equals a resonant wavelength shift of 1.514 nm when the index of the cladding changes by 0.017 refractive index units (RIUs), or at a rate of 89.05 nm/RIU.

The Role of Chiropractic Care in Providing Health Promotion and Clinical Preventive Services for Adult Patients with Musculoskeletal Pain: A Clinical Practice Guideline.

Objective: To develop evidence-based recommendations on best practices for delivery of clinical preventive services by chiropractors and to offer practical resources to empower provider applications in practice. Design: Clinical practice guideline based on evidence-based recommendations of a panel of practitioners and experts on clinical preventive services. Methods: Synthesizing the results of a literature search for relevant clinical practice guidelines and systematic reviews, a multidisciplinary steering committee with training and experience in health promotion, clinical prevention, and/or evidence-based chiropractic practice drafted a set of recommendations. A Delphi panel of experienced practitioners and faculty, primarily but not exclusively chiropractors, rated the recommendations by using the formal consensus methodology established by the RAND Corporation/University of California. Results: The Delphi consensus process was conducted during January-February 2021. The 65-member Delphi panel reached a high level of consensus on appropriate application of clinical preventive services for screening and health promotion counseling within the chiropractic scope of practice. Interprofessional collaboration for the successful delivery of clinical preventive services was emphasized. Recommendations were made on primary, secondary, tertiary, and quaternary prevention of musculoskeletal pain. Conclusions: Application of this guideline in chiropractic practice may facilitate consistent and appropriate use of screening and preventive services and foster interprofessional collaboration to promote clinical preventive services and contribute to improved public health.

Suicide prevention, public health, and the chiropractic profession: a call to action.

BACKGROUND: Suicide is a major public health concern that has wide-reaching implications on individuals, families, and society. Efforts to respond to a public health concern as a portal-of-entry provider can reduce morbidity and mortality of patients. The objective of this commentary is a call to action to initiate dialogue regarding suicide prevention and the role the chiropractic profession may play. DISCUSSION: This public health burden requires doctors of chiropractic to realize current strengths and recognize contemporaneous deficiencies in clinical, research, and policy environments. With this better understanding, only then can the chiropractic profession strive to enhance knowledge and promote clinical acumen to target and mitigate suicide risk to better serve the public. CONCLUSION: We implore the profession to transition from bystander to actively engaged in the culture of suicide prevention beholden to all aspects of the biopsychosocial healthcare model. The chiropractic profession's participation in suicide prevention improves the health and wellness of one's community while also impacting the broader public health arena.

Extending the Morphological Hit-or-Miss Transform to Deep Neural Networks.

While most deep learning architectures are built on convolution, alternative foundations such as morphology are being explored for purposes such as interpretability and its connection to the analysis and processing of geometric structures. The morphological hit-or-miss operation has the advantage that it considers both foreground information and background information when evaluating the target shape in an image. In this article, we identify limitations in the existing hit-or-miss neural definitions and formulate an optimization problem to learn the transform relative to deeper architectures. To this end, we model the semantically important condition that the intersection of the hit and miss structuring elements (SEs) should be empty and present a way to express Don't Care (DNC), which is important for denoting regions of an SE that are not relevant to detecting a target pattern. Our analysis shows that convolution, in fact, acts like a hit-to-miss transform through semantic interpretation of its filter differences. On these premises, we introduce an extension that outperforms conventional convolution on benchmark data. Quantitative experiments are provided on synthetic and benchmark data, showing that the direct encoding hit-or-miss transform provides better interpretability on learned shapes consistent with objects, whereas our morphologically inspired generalized convolution yields higher classification accuracy. Finally, qualitative hit and miss filter visualizations are provided relative to single morphological layer.

Precipitation contributes to plant height, but not reproductive effort, for western prairie fringed orchid (Platanthera praeclara Sheviak & Bowles): Evidence from herbarium records.

The western fringed prairie orchid (WFPO) is a rare plant found in mesic to wet tallgrass prairies in the Great Plains and Midwest regions of the United States. The size of WFPO populations varies considerably from year to year, and studies have suggested that population size is dependent on precipitation during critical periods in the plant's annual development. We hypothesized that plant height and reproductive effort would also be controlled by precipitation, either during these periods or over a broader period. We acquired available images of WFPO from 21 herbaria, and of these 141 individual plants had information adequate for analysis, although some population/year combinations were represented multiple times. For each specimen, we measured plant height (cm) and reproductive effort (as measured by total flower and bud count). We used bootstrapped linear regression, randomly selecting one individual from each population/year combination, to compare precipitation models, both during critical periods and the various summaries. We found that precipitation during the phenologically critical periods was a poor predictor of plant height and reproductive effort. Of the broader precipitation variables, accumulated precipitation from January 1 to collection date best described plant height. We also used correlations to detect a relationship among the variables WFPO height, reproductive effort, precipitation, latitude, and year of collection. Year of specimen collection was negatively correlated with WFPO plant height and accumulated precipitation, suggesting that both have declined in more recent years. Negative correlations with latitude also suggest height and precipitation decrease in the northern part of WFPO's range. Reproductive effort was not related to tested precipitation variables; however, it was weakly correlated with plant height. Although the results are limited, this study leverages available data and makes inferences on WFPO biology over broad ranges of time (1894-2012) and latitude (37.5°-49.9°).

Best Practices for Chiropractic Management of Patients with Chronic Musculoskeletal Pain: A Clinical Practice Guideline.

Objective: To develop an evidence-based clinical practice guideline (CPG) through a broad-based consensus process on best practices for chiropractic management of patients with chronic musculoskeletal (MSK) pain. Design: CPG based on evidence-based recommendations of a panel of experts in chronic MSK pain management. Methods: Using systematic reviews identified in an initial literature search, a steering committee of experts in research and management of patients with chronic MSK pain drafted a set of recommendations. Additional supportive literature was identified to supplement gaps in the evidence base. A multidisciplinary panel of experienced practitioners and educators rated the recommendations through a formal Delphi consensus process using the RAND Corporation/University of California, Los Angeles, methodology. Results: The Delphi process was conducted January-February 2020. The 62-member Delphi panel reached consensus on chiropractic management of five common chronic MSK pain conditions: low-back pain (LBP), neck pain, tension headache, osteoarthritis (knee and hip), and fibromyalgia. Recommendations were made for nonpharmacological treatments, including acupuncture, spinal manipulation/mobilization, and other manual therapy; modalities such as low-level laser and interferential current; exercise, including yoga; mind-body interventions, including mindfulness meditation and cognitive behavior therapy; and lifestyle modifications such as diet and tobacco cessation. Recommendations covered many aspects of the clinical encounter, from informed consent through diagnosis, assessment, treatment planning and implementation, and concurrent management and referral. Appropriate referral and comanagement were emphasized. Conclusions: These evidence-based recommendations for a variety of conservative treatment approaches to the management of common chronic MSK pain conditions may advance consistency of care, foster collaboration between provider groups, and thereby improve patient outcomes.

Military Sexual Trauma and Chronic Pain in Veterans.

OBJECTIVE: Chronic pain rehabilitation warrants sensitivity to unique psychosocial factors, such as trauma history. In Veterans of the United States Armed Forces, military sexual trauma (MST) is a pervasive type of trauma associated with a host of physical and psychological sequelae. A growing literature suggests a relationship between history of MST and chronic pain. This study sought to clarify the relationship between MST and chronic pain among male and female Veterans and explore whether individual factors moderate this relationship. DESIGN: A baseline survey of 328 Veterans seeking care for chronic pain via behavioral pain treatments was conducted. RESULTS: MST was reported by 31.4% of the sample and uniquely predicted pain interference. A significant interaction was found between MST and age, such that younger Veterans with a history of MST reported greater pain interference than younger Veterans with no MST. CONCLUSION: Findings provide further evidence that the experience of MST may intensify the overall burden of chronic pain and suggest that younger Veterans with MST seem to be most vulnerable to impaired pain rehabilitation. Unique study contributions include a robust sample of women and men with elevated rates of MST and examination of MST-age relationships concurrent with chronic pain.

Higher Anxiety and Will to Live Are Associated With Poorer Adherence to Cardiac Rehabilitation.

PURPOSE: Cardiac rehabilitation (CR) session attendance and rates of completion remain suboptimal. Greater distress (ie, depression and anxiety) has been associated with both better and poorer adherence. Will to live (ie, desire, determination and effort to survive) has been associated with survival among cardiac patients and thus may be relevant for CR adherence. It was hypothesized that depression and anxiety would be negatively associated with adherence, and that will to live would moderate these relationships. METHODS: Sixty patients (mean age = 56.9 ± 10.8 yr; 38 males) entering outpatient CR completed self-report measures of will to live (Wish to Prolong Life Questionnaire) and distress (Hospital Anxiety and Depression Scale). Hierarchical regression analyses were performed to predict CR session attendance (%) and program completion (yes/no) from depression and anxiety, as well as the interaction of those variables with will to live. RESULTS: Neither depression nor anxiety was associated with CR adherence (Ps > .33). However, there was a significant interaction of will to live with anxiety in predicting attendance (ß= -0.31, P = .03, Model R = .19, P = .01), reflecting that anxiety predicted lower attendance only among patients reporting greater will to live. CONCLUSIONS: These data help clarify the complex relationship between distress and CR adherence. Findings suggest that higher anxiety is associated with poorer adherence, but only in combination with greater motivation for living. Patients higher in anxiety and will to live may benefit from additional strategies to make actionable behavioral change in the context of CR.

Survey and Insights into Unmanned Aerial-Vehicle-Based Detection and Documentation of Clandestine Graves and Human Remains.

Numerous biological and archaeological studies have demonstrated the legitimacy of remote sensing in anthropology. This article focuses on detecting and documenting terrestrial clandestine graves and surface remains (CGSR) of humans using unmanned aerial vehicles (UAVs), sensors, and automatic processing algorithms. CGSR is a problem of complex decision making under uncertainty that requires the identification and intelligent reasoning about direct evidence of human remains and their environmental fingerprints. As such, it is as much an engineering and geospatial problem as it is an anthropology problem. This article is an effort to survey existing work across disciplines and to provide insights and recommendations to assist future research. To support our claims, preliminary experiments were performed at the Forensic Anthropological Research Facility at Texas State University using UAVs, hyperspectral imaging, thermal imaging, and structure from motion. Prior work, our experience, and preliminary results indicate that both great potential and extreme challenges face remote sensing of CGSR.

Pseudomonas aeruginosa responds to exogenous polyunsaturated fatty acids (PUFAs) by modifying phospholipid composition, membrane permeability, and phenotypes associated with virulence.

BACKGROUND: Pseudomonas aeruginosa, a common opportunistic pathogen, is known to cause infections in a variety of compromised human tissues. An emerging mechanism for microbial survival is the incorporation of exogenous fatty acids to alter the cell's membrane phospholipid profile. With these findings, we show that exogenous fatty acid exposure leads to changes in bacterial membrane phospholipid structure, membrane permeability, virulence phenotypes and consequent stress responses that may influence survival and persistence of Pseudomonas aeruginosa. RESULTS: Thin-layer chromatography and ultra performance liquid chromatography / ESI-mass spectrometry indicated alteration of bacterial phospholipid profiles following growth in the presence of polyunsaturated fatty acids (PUFAs) (ranging in carbon length and unsaturation). The exogenously supplied fatty acids were incorporated into the major bacterial phospholipids phosphatidylethanolamine and phosphatidylglycerol. The incorporation of fatty acids increased membrane permeability as judged by both accumulation and exclusion of ethidium bromide. Individual fatty acids were identified as modifying resistance to the cyclic peptide antibiotics polymyxin B and colistin, but not the beta-lactam imipenem. Biofilm formation was increased by several PUFAs and significant fluctuations in swimming motility were observed. CONCLUSIONS: Our results emphasize the relevance and complexity of exogenous fatty acids in the membrane physiology and pathobiology of a medically important pathogen. P. aeruginosa exhibits versatility with regard to utilization of and response to exogenous fatty acids, perhaps revealing potential strategies for prevention and control of infection.

Validation Strategy for Ultrasensitive Mutation Detection.

BACKGROUND: Ultrasensitive detection of low-abundance DNA point mutations is a challenging molecular biology problem, because nearly identical mutant and wild-type molecules exhibit crosstalk. Reliable ultrasensitive point mutation detection will facilitate early detection of cancer and therapeutic monitoring of cancer patients. OBJECTIVE: The objective of this study was to develop a method to correct errors in low-level cell line mixes. MATERIALS AND METHODS: We tested sample mixes with digital-droplet PCR (ddPCR) and next-generation sequencing. RESULTS: We introduced two corrections: baseline variant allele frequency (VAF) in the parental cell line was used to correct for copy number variation; and haplotype counting was used to correct errors in cell counting and pipetting. We found ddPCR to have better correlation for detecting low-level mutations without applying any correction (R2 = 0.80) and be more linear after introducing both corrections (R2 = 0.99). CONCLUSIONS: The VAF correction was found to be more significant than haplotype correction. It is imperative that various technologies be evaluated against each other and laboratories be provided with defined quality control samples for proficiency testing.