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Dual-energy X-ray absorptiometry (DXA) is underutilized to measure bone mineral density (BMD) and evaluate fracture risk. We present an automated tool to identify fractures, predict BMD, and evaluate fracture risk using plain radiographs. The tool performance is evaluated on 5164 and 18175 patients with pelvis/lumbar spine radiographs and Hologic DXA. The model is well calibrated with minimal bias in the hip (slope = 0.982, calibration-in-the-large = −0.003) and the lumbar spine BMD (slope = 0.978, calibration-in-the-large = 0.003). The area under the precision-recall curve and accuracy are 0.89 and 91.7% for hip osteoporosis, 0.89 and 86.2% for spine osteoporosis, 0.83 and 95.0% for high 10-year major fracture risk, and 0.96 and 90.0% for high hip fracture risk. The tool classifies 5206 (84.8%) patients with 95% positive or negative predictive value for osteoporosis, compared to 3008 DXA conducted at the same study period. This automated tool may help identify high-risk patients for osteoporosis. Dual-energy X-ray absorptiometry and the Fracture Risk Assessment Tool are recommended tools for osteoporotic fracture risk evaluation, but are underutilized. Here, the authors present an opportunistic tool to identify fractures, predict bone mineral density and evaluate fracture risk using plain pelvis and lumbar spine radiographs.

Objectives To describe trends in the epidemiology of gout and patterns of urate-lowering treatment (ULT) in the UK general population from 1997 to 2012. Methods We used the Clinical Practice Research Datalink to estimate the prevalence and incidence of gout for each calendar year from 1997 to 2012. We also investigated the pattern of gout management for both prevalent and incident gout patients. Results In 2012, the prevalence of gout was 2.49% (95% CI 2.48% to 2.51%) and the incidence was 1.77 (95% CI 1.73 to 1.81) per 1000 person-years. Prevalence and incidence both were significantly higher in 2012 than in 1997, with a 63.9% increase in prevalence and 29.6% increase in incidence over this period. Regions with highest prevalence and incidence were the North East and Wales. Among prevalent gout patients in 2012, only 48.48% (95% CI 48.08% to 48.89%) were being consulted specifically for gout or treated with ULT and of these 37.63% (95% CI 37.28% to 38.99%) received ULT. In addition, only 18.6% (95% CI 17.6% to 19.6%) of incident gout patients received ULT within 6 months and 27.3% (95% CI 26.1% to 28.5%) within 12 months of diagnosis. The management of prevalent and incident gout patients remained essentially the same during the study period, although the percentage of adherent patients improved from 28.28% (95% CI 27.33% to 29.26%) in 1997 to 39.66% (95% CI 39.11% to 40.22%) in 2012. Conclusions In recent years, both the prevalence and incidence of gout have increased significantly in the UK. Suboptimal use of ULT has not changed between 1997 and 2012. Patient adherence has improved during the study period, but it remains poor.

Large Language Models (LLMs) are capable of transforming healthcare by demonstrating remarkable capabilities in language understanding and generation. They have matched or surpassed human performance in standardized medical examinations and assisted in diagnostics across specialties like dermatology, radiology, and ophthalmology. LLMs can enhance patient education by providing accurate, readable, and empathetic responses, and they can streamline clinical workflows through efficient information extraction from unstructured data such as clinical notes. Integrating LLM into clinical practice involves user interface design, clinician training, and effective collaboration between Artificial Intelligence (AI) systems and healthcare professionals. Users must possess a solid understanding of generative AI and domain knowledge to assess the generated content critically. Ethical considerations to ensure patient privacy, data security, mitigating biases, and maintaining transparency are critical for responsible deployment. Future directions for LLMs in healthcare include interdisciplinary collaboration, developing new benchmarks that incorporate safety and ethical measures, advancing multimodal LLMs that integrate text and imaging data, creating LLM-based medical agents capable of complex decision-making, addressing underrepresented specialties like rare diseases, and integrating LLMs with robotic systems to enhance precision in procedures. Emphasizing patient safety, ethical integrity, and human-centered implementation is essential for maximizing the benefits of LLMs, while mitigating potential risks, thereby helping to ensure that these AI tools enhance rather than replace human expertise and compassion in healthcare.

An investigation was conducted to develop an effective automated tool to deploy micro-fabricated stretchable networks of distributed sensors onto the surface of large structures at macroscale to create “smart” structures with embedded distributed sensor networks. Integrating a large network of distributed sensors with structures has been a major challenge in the design of so-called smart structures or devices for cyber-physical applications where a large amount of usage data from structures or devices can be generated for artificial intelligence applications. Indeed, many “island-and-serpentine”-type distributed sensor networks, while promising, remain difficult to deploy. This study aims to enable such networks to be deployed in a safe, automated, and efficient way. To this end, a scissor-hinge controlled system was proposed as the basis for a deployment mechanism for such stretchable sensor networks (SSNs). A model based on a kinematic scissor-hinge mechanism was developed to simulate and design the proposed system to automatically stretch a micro-scaled square network with uniformly distributed sensor nodes. A prototype of an automatic scissor-hinge stretchable tool was constructed during the study with an array of four scissor-hinge mechanisms, each belt-driven by a single stepper motor. Two micro-fabricated SSNs from a 100 mm wafer were fabricated at the Stanford Nanofabrication Facility for this deployment study. The networks were designed to be able to cover an area 100 times their manufacturing size (from a 100 mm diameter wafer to a 1 m2 active area) once stretched. It was demonstrated that the proposed deployment tool could place sensor nodes in prescribed locations efficiently within a drastically shorter time than in current labor-intensive manual deployment methods.

An investigation was performed to develop a process to design and manufacture a 3-D smart skin with an embedded network of distributed sensors for non-developable (or doubly curved) surfaces. A smart skin is the sensing component of a smart structure, allowing such structures to gather data from their surrounding environments to make control and maintenance decisions. Such smart skins are desired across a wide variety of domains, particularly for those devices where their surfaces require high sensitivity to external loads or environmental changes such as human-assisting robots, medical devices, wearable health components, etc. However, the fabrication and deployment of a network of distributed sensors on non-developable surfaces faces steep challenges. These challenges include the conformal coverage of a target object without causing prohibitive stresses in the sensor interconnects and ensuring positional accuracy in the skin sensor deployment positions, as well as packaging challenges resulting from the thin, flexible form factor of the skin. In this study, novel and streamlined processes for making such 3-D smart skins were developed from the initial sensor network design to the final integrated skin assembly. Specifically, the process involved the design of the network itself (for which a physical simulation-based optimization was developed), the deployment of the network to a targeted 3D surface (for which a specialized tool was designed and implemented), and the assembly of the final skin (for which a novel process based on dip coating was developed and implemented.)

The vibration of a wing structure in the air reflects coupled aerodynamic–mechanical responses under varying flight states that are defined by the angle of attack and airspeed. It is of great challenge to identify the flight state from the complex vibration signals. In this paper, a novel one-dimension convolutional neural network (CNN) is developed, which is able to automatically extract useful features from the structural vibration of a recently fabricated self-sensing wing through wind-tunnel experiments. The obtained signals are firstly decomposed into various subsignals with different frequency bands via dual-tree complex-wavelet packet transformation. Then, the reconstructed subsignals are selected to form the best combination for multichannel inputs of the CNN. A swarm-based evolutionary algorithm called grey-wolf optimizer is utilized to optimize a set of key parameters of the CNN, which saves considerable human efforts. Two case studies demonstrate the high identification accuracy and robustness of the proposed method over standard deep-learning methods in flight-state identification, thus providing new perspectives in self-awareness toward the next generation of intelligent air vehicles.

Detection of nodal micrometastasis (tumor size: 0.2–2.0 mm) is challenging for pathologists due to the small size of metastatic foci. Since lymph nodes with micrometastasis are counted as positive nodes, detecting micrometastasis is crucial for accurate pathologic staging of colorectal cancer. Previously, deep learning algorithms developed with manually annotated images performed well in identifying micrometastasis of breast cancer in sentinel lymph nodes. However, the process of manual annotation is labor intensive and time consuming. Multiple instance learning was later used to identify metastatic breast cancer without manual annotation, but its performance appears worse in detecting micrometastasis. Here, we developed a deep learning model using whole-slide images of regional lymph nodes of colorectal cancer with only a slide-level label (either a positive or negative slide). The training, validation, and testing sets included 1963, 219, and 1000 slides, respectively. A supercomputer TAIWANIA 2 was used to train a deep learning model to identify metastasis. At slide level, our algorithm performed well in identifying both macrometastasis (tumor size > 2.0 mm) and micrometastasis with an area under the receiver operating characteristics curve (AUC) of 0.9993 and 0.9956, respectively. Since most of our slides had more than one lymph node, we then tested the performance of our algorithm on 538 single-lymph node images randomly cropped from the testing set. At single-lymph node level, our algorithm maintained good performance in identifying macrometastasis and micrometastasis with an AUC of 0.9944 and 0.9476, respectively. Visualization using class activation mapping confirmed that our model identified nodal metastasis based on areas of tumor cells. Our results demonstrate for the first time that micrometastasis could be detected by deep learning on whole-slide images without manual annotation.

Tactile sensing is paramount for robots operating in human-centered environments to help in understanding interaction with objects. To enable robots to have sophisticated tactile sensing capability, researchers have developed different kinds of electronic skins for robotic hands and arms in order to realize the ‘sense of touch’. Recently, Stanford Structures and Composites Laboratory developed a robotic electronic skin based on a network of multi-modal micro-sensors. This skin was able to identify temperature profiles and detect arm strikes through embedded sensors. However, sensing for the static pressure load is yet to be investigated. In this work, an electromechanical impedance-based method is proposed to investigate the response of piezoelectric sensors under static normal pressure loads. The smart skin sample was firstly fabricated by embedding a piezoelectric sensor into the soft silicone. Then, a series of static pressure tests to the skin were conducted. Test results showed that the first peak of the real part impedance signal was sensitive to static pressure load, and by using the proposed diagnostic method, this test setup could detect a resolution of 0.5 N force. Numerical simulation methods were then performed to validate the experimental results. The results of the numerical simulation prove the validity of the experiments, as well as the robustness of the proposed method in detecting static pressure loads using the smart skin.

Objectives Observational studies have demonstrated associations between gout and hypertension, but whether they are causal remains unclear. Our work aims to assess the causal relationship between gout and hypertension. Methods We obtained genetic information from the Taiwan Biobank, including 88,347 participants and 686,439 single-nucleotide polymorphisms (SNPs). A novel model of Mendelian randomisation (MR) with coarsened exposures was used to examine the causality between the liability of gout on hypertension and vice versa, using 4 SNPs associated with gout and 10 SNPs associated with hypertension after removal of SNPs associated with measured confounders. The binary exposure (gout/hypertension) can be considered a coarsened approximation of a latent continuous trait. The inverse-variance weighted (IVW) and polygenic risk score (PRS) methods were used to estimate effect size. The MR analysis with coarsened exposures was performed with and without adjustments for covariates. Results Of the 88,347 participants, 3253 (3.68%) had gout and 11,948 (13.52%) had hypertension (men, 31.9%; mean age 51.1 [SD, 11.1] years). After adjusting to measured confounders, MR analysis with coarsened exposures showed a significant positive causal effect of the liability of gout on hypertension in both the IVW method (relative risk [RR], 1.10; 95% confidence interval [CI], 1.03–1.19; p  = 0.0077) and the PRS method (RR, 1.10; 95% CI, 1.02–1.19; p  = 0.0092). The result of causality was the same before and after involving measured confounders. However, there was no causal effect of the liability of hypertension on gout. Conclusions In this study, we showed that the liability of gout has a causal effect on hypertension, but the liability of hypertension does not have a causal effect on gout. Adequate management of gout may reduce the risk of developing hypertension.

Developmental dysplasia of the hip (DDH) is a common congenital disorder that may lead to hip dislocation and requires surgical intervention if left untreated. Ultrasonography is the preferred method for DDH screening; however, the lack of experienced operators impedes its application in universal neonatal screening. We developed a deep neural network tool to automatically register the five keypoints that mark important anatomical structures of the hip and provide a reference for measuring alpha and beta angles following Graf's guidelines, which is an ultrasound classification system for DDH in infants. Two-dimensional (2D) ultrasonography images were obtained from 986 neonates aged 0-6 months. A total of 2406 images from 921 patients were labeled with ground truth keypoints by senior orthopedists. Our model demonstrated precise keypoint localization. The mean absolute error was approximately 1 mm, and the derived alpha angle measurement had a correlation coefficient of R = 0.89 between the model and ground truth. The model achieved an area under the receiver operating characteristic curve of 0.937 and 0.974 for classifying alpha <60° (abnormal hip) and <50° (dysplastic hip), respectively. On average, the experts agreed with 96% of the inferenced images, and the model could generalize its prediction on newly collected images with a correlation coefficient higher than 0.85. Precise localization and highly correlated performance metrics suggest that the model can be an efficient tool for assisting DDH diagnosis in clinical settings.