Adapting Audiology Procedures During the Pandemic: Validity and Efficacy of Testing Outside a Sound Booth

Purpose: This investigation aims to provide outcomes from a clinical perspective on the validity and efficacy of a wireless automated audiometer system that could be used in multiple settings when a sound booth is not accessible. Testing was conducted in a clinical setting under modified protocols meeting safety precautions during the COVID-19 pandemic. Method: Four doctoral students in audiology served as examiners. Participants were 69 adults between the ages of 20 and 69 years, with normal hearing (≤ 25 dB HL; n = 110 ears) or hearing loss (> 25 dB HL; n = 25 ears). Two versions of a pure-tone air-conduction threshold test following a modified Hughson-Westlake approach were performed and compared at 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz (a) in a sound-treated test booth using standard manual audiometry and (b) in a quiet, nonsound-treated clinical room (sound booth free) using automated KUDUwave audiometry. Participants were asked to complete a five-item feedback questionnaire, and examiners were interviewed to report on their experience. Results: Clinical validity to within ±10 dB of standard audiometry was demonstrated for 94.5% of the total thresholds ( n = 937) measured with the sound booth–free approach. Less accuracy (73.3%) was observed using a ±5 dB comparison. When comparing the mean thresholds, there were significant differences ( p < .01) between the mean thresholds at most frequencies, with mean sound booth thresholds being higher than the sound booth–free mean thresholds. A strong threshold correlation (.91–.98) was found between the methods across frequencies. Participant and examiner feedback supported the efficacy of the sound booth–free technology. Conclusions: Findings support sound booth–free, automated software-controlled audiometry with active noise monitoring as a valid and efficient procedure for pure-tone hearing threshold assessment. This method offers an effective alternative when circumstances require more transportable hearing assessment technology or do not allow for standard manual audiometry in a sound booth.

RADT-35. CHANGE IN HIPPOCAMPAL VOLUME AS A FUNCTION OF RADIATION DOSE: RESULTS FROM A PROSPECTIVE TRIAL WITH STANDARDIZED IMAGING AND MORPHOMETRIC EVALUATION

PURPOSE/OBJECTIVES MRIs in pediatric and adult brain tumor patients (Age&lt; 35) were prospectively collected at baseline and during follow-up to measure volumetric changes in multiple brain substructures with neurocognitive, laboratory, and quality-of-life assessments. In this planned interim analysis, we model early outcomes for change in hippocampal volume at 6 months following radiotherapy. MATERIALS AND METHODS As of 5/15/2021, 50 patients enrolled on this prospective study and 41 completed 6-month post-treatment assessments after fractionated intensity-modulated proton therapy. Left and right hippocampus volumes were independently measured on T1 sagittal precontrast MRI at baseline and 6-months after radiotherapy using both automated software and physician-delineated contours. The relationship between mean hippocampus dose and change in volume was assessed by Pearson’s correlation coefficient. A linear mixed-effects model was applied to evaluate other predictors associated with change in hippocampal volume, assuming random effects of subjects. RESULTS Mean hippocampus dose was strongly correlated with change in hippocampal volume at 6 months following radiotherapy (r=−0.727, 95% CI [-0.820,-0.596], p&lt; 0.001). Changes in hippocampal volumes over time were similar between software and physician contours. Hippocampal volume was significantly reduced for mean doses ≥10 Gy (mean Δ -10.8% ± 5.5%, p&lt; 0.001), while no significant volume change was observed with mean doses &lt; 10 Gy (mean Δ +0.7% ± 3.9%). In the mixed-effects model, only mean hippocampus dose was significantly associated with hippocampal volume change (p&lt; 0.001). The final model predicted a -3.4% change in hippocampal volume for every 10 Gy increase in mean dose. CONCLUSIONS Change in hippocampal volume was correlated with hippocampus mean dose at 6 months following radiotherapy. Future analyses will assess volume change in the hippocampus and other brain substructures over time as a function of radiation dose and correlate with measured neurocognitive and other effects.

Expression of p16 Within Myenteric Neurons of the Aged Colon: A Potential Marker of Declining Function

Human colonic neuromuscular functions decline among the elderly. The aim was to explore the involvement of senescence. A preliminary PCR study looked for age-dependent differences in expression of CDKN1A (encoding the senescence-related p21 protein) and CDKN2A (encoding p16 and p14) in human ascending and descending colon (without mucosa) from 39 (approximately 50: 50 male: female) adult (aged 27–60 years) and elderly donors (70–89 years). Other genes from different aging pathways (e.g., inflammation, oxidative stress, autophagy) and cell-types (e.g., neurons, neuron axonal transport) were also examined. Unlike CDKN1A, CDKN2A (using primers for p16 and p14 but not when using p14-specific primers) was upregulated in both regions of colon. Compared with the number of genes appearing to upregulate in association with temporal age, more genes positively associated with increased CDKN2A expression (respectively, 16 and five of 44 genes studied for ascending and descending colon). Confirmation of increased expression of CDKN2A was sought by immunostaining for p16 in the myenteric plexus of colon from 52 patients, using a semi-automated software protocol. The results showed increased staining not within the glial cells (S100 stained), but in the cytoplasm of myenteric nerve cell bodies (MAP2 stained, with identified nucleus) of ascending, but not descending colon of the elderly, and not in the cell nucleus of either region or age group (5,710 neurons analyzed: n = 12–14 for each group). It was concluded that increased p16 staining within the cytoplasm of myenteric nerve cell bodies of elderly ascending (but not descending) colon, suggests a region-dependent, post-mitotic cellular senescence-like activity, perhaps involved with aging of enteric neurons within the colon.

Independent predictors of major cardiovascular events as quantitatively assessed by coronary CT-angiography: a long-term follow-up analysis

Introduction Quantitative CT coronary angiography using semi-automated software provides detailed information about plaque volume and high-risk plaque characteristics, beyond traditional measures like diameter stenosis. We assessed the potential value of plaque quantity and morphology to independently predict MACE in a cohort with long-term follow up. Methods In this secondary analysis of 301 symptomatic patients undergoing coronary CTA at baseline, total plaque volume (TPV), non-calcified- (NCPV), calcified- (CPV) and vulnerable coronary plaque volume (in mm3), diameter stenosis (in %) and remodeling index were quantified using semi-automated software (Autoplaque version 2.5, Cedars-Sinai Medical Center, Los Angeles, CA). Patients were followed for major cardiovascular events (MACE), defined as a composite of cardiovascular death, myocardial infarction and coronary revascularization. Optimal thresholds for each quantitative CTA measure were computed using CART-algorithm (Classification and Regression Trees). Results Complete follow-up was available for 234 (78%) patients. The mean age was 59±10 years. Over a median follow-up of 10.7 years, the composite outcome occurred in 34 (15%) patients (5 patients with cardiovascular death, 6 with myocardial infarction, 26 with revascularization). Patients experiencing MACE had more frequently hypertension (p=0.03) and a higher Framingham risk score (p=0.002). Survival anaylsis using cox proportional hazard ratios showed significant univariate associations between MACE and TPV (HR 5.16; 95% CI 1.58–16.89; p=0.007), NCPV (HR 4.83; 95% CI 1.45–15.81; p=0.009), CPV (HR 2.86; 95% CI 1.39–5.86; p=0.004), vulnerable plaque volume (HR 3.35; 95% CI 1.52–7.41; p=0.003), diameter stenosis (HR 5.19; 95% CI 2.64–10.22; p&lt;0.001) and remodeling index (HR 4.24; 95% CI 2.03–8.86; p&lt;0.001). In multivariable cox regression analysis diameter stenosis (HR 3.70; 95% CI 1.72–7.93; p=0.001) and remodeling index (HR 2.69; 95% CI 1.19–6.09; p=0.018) remained significant independent predictors of MACE, adjusted for Framingham risk score (HR 2.56; 95% CI 1.26–5.22; p=0.010), however plaque volume and plaque subcomponents did not. Conclusion On long term follow-up, remodeling index and coronary diameter stenosis obtained by quantitative coronary CT angiography independently predicted MACE on multivariable assessment. More comprehensive plaque assessment algorithms including plaque volume as well as plaque subcomponents were significantly associated with MACE in univariate, but not multivariate analysis after adjustment for diameter stenosis and remodeling index. FUNDunding Acknowledgement Type of funding sources: None.

O035 Automated vs. expert manual analysis of the Multiple Sleep Latency Test

Purpose To compare Compumedics Profusion PSG™ automated sleep analysis of Multiple Sleep Latency Tests (MSLTs) with expert consensus manual analysis. Methods Consecutive PSG with MSLTs were analysed using automated software (Compumedics Ltd (Abbottsford, Victoria, Australia) Profusion PSG™ V4.5 Build 531) (‘Auto’) and by two of nine experienced scientists. Discrepancies between scientists were discussed to establish expert consensus (‘Final’). Results Fifty consecutive patients referred for investigation of Narcolepsy were included. Two were excluded due to poor signal quality (1) and early test termination (1). The remaining 48 (37 M, 10 F, 1) had a median (range) age of 37 (17–63) years, BMI 28.0 (19.9–66.1) kg/m2, and mean sleep latency (MSL) 14.0 (1.5–20.0) minutes. Of five MSLTs with MSL &lt;=8 min, Auto-MSL was also &lt;=8 min. Of 43 MSLTs with MSL &gt;=8 min, Auto-MSL was &lt;=8 min in 12. MSL sensitivity was 100% and specificity 72%. For the one MSLT with &gt;=2 SOREMs, Auto identified 1 SOREM. Nap-wise, Auto-SOREM sensitivity was 17% and specificity 98%; one of six REM-positive naps was detected by auto-analysis and there were seven false positive and five false negative SOREM results. Conclusions (1) Automated analysis poorly detected short MSL and SOREM occurrence but was able to rule out all true-negative MSLT results, in this MSLT dataset. (2) This comparison methodology and dataset facilitates robust prospective testing of other current and future algorithms.

A Massively Parallel Approach to Automated Software Correctness Enhancement in Java

Software product faults are an inevitable and an undesirable byproduct of any software development. Often hard to detect they are a major contributing factor to the overall development and support costs and a source of technical risk for the application as a whole. The criticality of the impact has resulted in several decades of non-stop iterative improvements, aimed at avoiding and detecting the faults through development and application of sophisticated automated testing and validation systems, Finding the exact source of error, creating a patch to fix it and validating it for production release is still a highly manual activity. In this paper we build upon the theoretical framework of relative correctness, which we have laid out in our previous work, and present a massively parallel automated tool implementing it in order to support root cause analysis and patch generation.

The study of systemic hemodynamics by the method of volumetric compression oscillometry in young people

Aim. To investigate the state of systemic hemodynamics (SHD) in young people to assess the potential impact of its disorders in the formation of arterial hypertension (AH) and to carry out preventive measures.Methods. A random sample of 91 young people from 17 to 25 years old was examined; 27 of them were men (average age 23.7±1.6 years) and 64 women (average age 20.4±1.1 years). The study involved clinical residents and students who, according to preliminary and periodic medical examinations, excluded the presence of cardiovascular diseases. The indicators of SHD were investigated by the method of volumetric compression oscillometry using a portable automated software and hardware complex for non-invasive research of central hemodynamics (Device “CAP TsG osm-“Globus”).Results. AH was detected in 4.4%; “white coat” AH in 8.79%; arterial hypotension – in 5.49%. In individuals with normal blood pressure (BP) (75 people), an increase in specific peripheral vascular resistance was most often revealed in 30.6%. An unchanged hemodynamic profile in the group with a normal BP level was recorded only in 28.0% of the examinees.Conclusion. The obtained results indicate that even among “healthy” young people aged 18- 25 years with a normal BP level, the proportion of people with impaired SHD values is 72%. People with hypertension and with altered SHD indicators should be included in the regular medical check-up observation group.

Assessment of a Multiplex LAMP Assay (Eazyplex® CSF Direct M) for Rapid Molecular Diagnosis of Bacterial Meningitis: Accuracy and Pitfalls

Background: Automated molecular panels are attractive tools for improving early meningitis diagnosis. This study assessed the Eazyplex® CSF direct M panel (EP), a multiplex real-time Loop-Mediated Isothermal Amplification assay. Methods: From December 2016 to December 2019, cerebrospinal fluid (CSF) samples were routinely tested with the EP V1.0. CSF parameters and microbiological and clinical data were retrospectively collected. Results: Out of 230 CSF samples, the EP yielded positive, negative, and invalid results for 32 (13.9%) (16 N. meningitidis, nine S. pneumoniae, two S. agalactiae, two E. coli, two H. influenzae, one L. monocytogenes), 182 (79.1%), and 16 (7%) samples, respectively. Among the positive samples, 14 (44%) remained negative in culture (antibiotic therapy before lumbar puncture (n = 11), meningococcal meningitis (n = 3)). High CSF protein concentrations and cellularity were associated with LAMP inhibition, counteracted by centrifugation. The automated software yielded 13 false positive and five false negative results. Amplification curve analysis was necessary and enabled the attainment of positive (PPA) and negative percentage agreement and positive and negative predictive values of 91.4%, 100%, 100%, and 98.3%. Three false negative results remained (two E. coli and one N. meningitidis). E. coli presented the poorest PPA (50%). Conclusion: This work confirms the strong performance of the EP, of particular interest in cases of antibiotic therapy before lumbar puncture.