Open Access. Powered by Scholars. Published by Universities.®

Operations Research, Systems Engineering and Industrial Engineering Commons

Open Access. Powered by Scholars. Published by Universities.®

Articles 1 - 22 of 22

Full-Text Articles in Operations Research, Systems Engineering and Industrial Engineering

Developing A High-Dimensional Dataset Of The Changes In Ion Channels Expression Level At The Cholinergic Boutons In Amyotrophic Lateral Sclerosis, Joshua Harris Jan 2018

Developing A High-Dimensional Dataset Of The Changes In Ion Channels Expression Level At The Cholinergic Boutons In Amyotrophic Lateral Sclerosis, Joshua Harris

The University Honors Program

ALS, or Amyotrophic Lateral Sclerosis, is a neurodegenerative disease that causes motor neuron degeneration. Affecting nerve cells in the brain and spinal cord, this disease eventually leads to respiratory muscle failure and death. Although ALS is fairly uncommon, our lack of information on how ALS develops drives the need for further study. In the Neuro Engineering, Rehabilitation, and Degeneration laboratory at Wright State University, immunohistochemical data has been collected on a mouse model (SOD1-G93A) throughout their lifespan to better examine the neurological effects of ALS. To better organize and interpret the data, a high-dimensional dataset was created in this project ...


Utilizing Functional Near-Infrared Spectroscopy For Prediction Of Cognitive Workload In Noisy Work Environments, Ryan Gabbard, Mary E. Fendley, Irfaan A. Dar, Rik Warren, Nasser H. Kashou Oct 2017

Utilizing Functional Near-Infrared Spectroscopy For Prediction Of Cognitive Workload In Noisy Work Environments, Ryan Gabbard, Mary E. Fendley, Irfaan A. Dar, Rik Warren, Nasser H. Kashou

Biomedical, Industrial & Human Factors Engineering Faculty Publications

Occupational noise frequently occurs in the work environment in military intelligence, surveillance, and reconnaissance operations. This impacts cognitive performance by acting as a stressor, potentially interfering with the analysts’ decision-making process. We investigated the effects of different noise stimuli on analysts’ performance and workload in anomaly detection by simulating a noisy work environment. We utilized functional near-infrared spectroscopy (fNIRS) to quantify oxy-hemoglobin (HbO) and deoxy-hemoglobin concentration changes in the prefrontal cortex (PFC), as well as behavioral measures, which include eye tracking, reaction time, and accuracy rate. We hypothesized that noisy environments would have a negative effect on the participant in ...


Brain Lesions Among Orally Fed And Gastrostomy-Fed Dysphagic Preterm Infants: Can Routine Qualitative Or Volumetric Quantitative Magnetic Resonance Imaging Predict Feeding Outcomes?, Nasser H. Kashou, Irfaan Akram Dar, Mohamed A. El-Mahdy, Charles Pluto, Mark Smith, Ish K. Gulati, Warren Lo, Sudarshan R. Jadcherla Apr 2017

Brain Lesions Among Orally Fed And Gastrostomy-Fed Dysphagic Preterm Infants: Can Routine Qualitative Or Volumetric Quantitative Magnetic Resonance Imaging Predict Feeding Outcomes?, Nasser H. Kashou, Irfaan Akram Dar, Mohamed A. El-Mahdy, Charles Pluto, Mark Smith, Ish K. Gulati, Warren Lo, Sudarshan R. Jadcherla

Biomedical, Industrial & Human Factors Engineering Faculty Publications

Introduction: The usefulness of qualitative or quantitative volumetric magnetic resonance imaging (MRI) in early detection of brain structural changes and prediction of adverse outcomes in neonatal illnesses warrants further investigation. Our aim was to correlate certain brain injuries and the brain volume of feeding-related cortical and subcortical regions with feeding method at discharge among preterm dysphagic infants.

Materials and methods: Using a retrospective observational study design, we examined MRI data among 43 (22 male; born at 31.5 ± 0.8 week gestation) infants who went home on oral feeding or gastrostomy feeding (G-tube). MRI scans were segmented, and volumes of ...


Somatic Stimulation Causes Frontoparietal Cortical Changes In Neonates: A Functional Near-Infrared Spectroscopy Study, Nasser H. Kashou, Irfaan Akram Dar, Kathryn Hasenstab, Ramzi W. Nahhas, Sudarshan R. Jadcherla Aug 2016

Somatic Stimulation Causes Frontoparietal Cortical Changes In Neonates: A Functional Near-Infrared Spectroscopy Study, Nasser H. Kashou, Irfaan Akram Dar, Kathryn Hasenstab, Ramzi W. Nahhas, Sudarshan R. Jadcherla

Biomedical, Industrial & Human Factors Engineering Faculty Publications

Palmar and plantar grasp are the foremost primitive neonatal reflexes and functions. Persistence of these reflexes in infancy is a sign of evolving cerebral palsy. Our aims were to establish measurement feasibility in a clinical setting and to characterize changes in oxyhemoglobin (HbO) and deoxyhemoglobin (HbD) concentration in the bilateral frontoparietal cortex in unsedated neonates at the crib-side using functional near-infrared spectroscopy (fNIRS). We hypothesized that bilateral concentration changes will occur upon somatic central and peripheral somatic stimulation. Thirteen preterm neonates (five males) underwent time 1, and six (two males) returned for time 2 (mean PMA ¼ 41.6 and ...


Long-Term Velaglucerase Alfa Treatment In Children With Gaucher Disease Type 1 Naïve To Enzyme Replacement Therapy Or Previously Treated With Imiglucerase, Laurie Smith, William Rhead, Joel Charrow, Suma P. Shankar, Ashish Bavdekar, Nicola Longo, Rebecca Mardach, Paul Harmatz, Thomas N. Hangartner, Hak-Myung Lee, Eric Crombez, Gregory M. Pastores Feb 2016

Long-Term Velaglucerase Alfa Treatment In Children With Gaucher Disease Type 1 Naïve To Enzyme Replacement Therapy Or Previously Treated With Imiglucerase, Laurie Smith, William Rhead, Joel Charrow, Suma P. Shankar, Ashish Bavdekar, Nicola Longo, Rebecca Mardach, Paul Harmatz, Thomas N. Hangartner, Hak-Myung Lee, Eric Crombez, Gregory M. Pastores

Biomedical, Industrial & Human Factors Engineering Faculty Publications

Background

Gaucher Disease type 1 (GD1) often manifests in childhood. Early treatment with enzyme replacement therapy (ERT) may prevent disease complications. We report the assessment of velaglucerase alfa ERT in pediatric GD1 patients who participated in a long-term extension study (HGT-GCB-044, ClinicalTrials.gov Identifier NCT00635427).

Methods

Safety and efficacy were evaluated in pediatric patients receiving velaglucerase alfa 30–60 U/kg by intravenous infusion every other week. In addition to key hematological and visceral efficacy assessments, exploratory assessments conducted specifically in pediatric patients included evaluation of height, bone age, bone marrow burden, and Tanner stage of puberty.

Results

The study ...


Stimulus And Optode Placement Effects On Functional Near-Infrared Spectroscopy Of Visual Cortex, Nasser H. Kashou, Brenna M. Giacherio Jan 2016

Stimulus And Optode Placement Effects On Functional Near-Infrared Spectroscopy Of Visual Cortex, Nasser H. Kashou, Brenna M. Giacherio

Biomedical, Industrial & Human Factors Engineering Faculty Publications

Functional near-infrared spectroscopy has yet to be implemented as a stand-alone technique within an ophthalmology clinical setting, despite its promising advantages. The present study aims to further investigate reliability of visual cortical signals. This was achieved by: (1) assessing the effects of optode placements using the 10–20 International System of Electrode Placement consisting of 28 channels, (2) determining effects of stimulus size on response, and (3) evaluating response variability as a result of cap placement across three sessions. Ten participants with mean age 23.8 4.8 years (five male) and varying types of hair color and thickness were ...


Hand-Grasping And Finger Tapping Induced Similar Functional Near-Infrared Spectroscopy Cortical Responses, Nasser H. Kashou, Brenna M. Giacherio, Ramzi W. Nahhas, Sudarshan R. Jadcherla Jan 2016

Hand-Grasping And Finger Tapping Induced Similar Functional Near-Infrared Spectroscopy Cortical Responses, Nasser H. Kashou, Brenna M. Giacherio, Ramzi W. Nahhas, Sudarshan R. Jadcherla

Biomedical, Industrial & Human Factors Engineering Faculty Publications

Despite promising advantages such as low cost and portability of functional near-infrared spectroscopy (fNIRS), it has yet to be widely implemented outside of basic research. Specifically, fNIRS has yet to be proven as a standalone tool within a clinical setting. The objective of this study was to assess hemodynamic concentration changes at the primary and premotor motor cortices as a result of simple whole-hand grasping and sequential finger-opposition (tapping) tasks. These tasks were repeated over 3 days in a randomized manner. Ten healthy young adults (23.8 4.8 years) participated in the study. Quantitatively, no statistically significant differences were ...


Safety And Efficacy Results Of Switch From Imiglucerase To Velaglucerase Alfa Treatment In Patients With Type 1 Gaucher Disease, Deborah Elstein, Atul Mehta, Derralynn A. Hughes, Pilar Giraldo, Joel Charrow, Laurie Smith, Suma P. Shankar, Thomas N. Hangartner, Yune Kunes, Nan Wang, Eric Crombez, Ari Zimran Jul 2015

Safety And Efficacy Results Of Switch From Imiglucerase To Velaglucerase Alfa Treatment In Patients With Type 1 Gaucher Disease, Deborah Elstein, Atul Mehta, Derralynn A. Hughes, Pilar Giraldo, Joel Charrow, Laurie Smith, Suma P. Shankar, Thomas N. Hangartner, Yune Kunes, Nan Wang, Eric Crombez, Ari Zimran

Biomedical, Industrial & Human Factors Engineering Faculty Publications

Gaucher disease (GD) is a lysosomal storage disorder; symptomatic patients with type 1 GD need long-term disease-specific therapy of which the standard of care has been enzyme replacement therapy (ERT). Thirty-eight of 40 patients (aged 9–71 years) clinically stable on ERT with imiglucerase, safely switched to a comparable dose of velaglucerase alfa (units/kg) during TKT034, a 12-month, open-label clinical study, and for 10–50 months in an extension study. The most common adverse events (AEs) judged to be drug-related in the extension were fatigue and bone pain. No drug-related serious AEs were reported. No AEs led to study ...


Velaglucerase Alfa (Vpriv) Enzyme Replacement Therapy In Patients With Gaucher Disease: Long-Term Data From Phase Iii Clinical Trials, Derralynn A. Hughes, Derlis Gonzalez, Elena A. Lukina, Atul Mehta, Madhulika Kabra, Deborah Elstein, Isaac Kisinovsky, Pilar Giraldo, Ashish Bavdekar, Thomas N. Hangartner, Nan Wang, Eric Crombez, Ari Zimran Jul 2015

Velaglucerase Alfa (Vpriv) Enzyme Replacement Therapy In Patients With Gaucher Disease: Long-Term Data From Phase Iii Clinical Trials, Derralynn A. Hughes, Derlis Gonzalez, Elena A. Lukina, Atul Mehta, Madhulika Kabra, Deborah Elstein, Isaac Kisinovsky, Pilar Giraldo, Ashish Bavdekar, Thomas N. Hangartner, Nan Wang, Eric Crombez, Ari Zimran

Biomedical, Industrial & Human Factors Engineering Faculty Publications

Type 1 Gaucher disease is an inherited lysosomal enzyme deficiency with variable age of symptom onset. Common presenting signs include thrombocytopenia, anemia, hepatosplenomegaly, bone abnormalities, and, additionally in children, growth failure. Fifty-seven patients aged 3–62 years at the baseline of two phase III trials for velaglucerase alfa treatment were enrolled in the single extension study. In the extension, they received every-other-week velaglucerase alfa intravenous infusions for 1.2–4.8 years at 60 U/kg, although 10 patients experienced dose reduction. No patient experienced a drug-related serious adverse event or withdrew due to an adverse event. One patient died ...


Oculomotor Neurocircuitry, A Structural Connectivity Study Of Infantile Nystagmus Syndrome, Nasser H. Kashou, Angelica R. Zampini Apr 2015

Oculomotor Neurocircuitry, A Structural Connectivity Study Of Infantile Nystagmus Syndrome, Nasser H. Kashou, Angelica R. Zampini

Biomedical, Industrial & Human Factors Engineering Faculty Publications

Infantile Nystagmus Syndrome (INS) is one of the leading causes of significant vision loss in children and affects about 1 in 1000 to 6000 births. In the present study, we are the first to investigate the structural pathways of patients and controls using diffusion tensor imaging (DTI). Specifically, three female INS patients from the same family were scanned, two sisters and a mother. Six regions of interest (ROIs) were created manually to analyze the number of tracks. Additionally, three ROI masks were analyzed using TBSS (Tract-Based Spatial Statistics). The number of fiber tracks was reduced in INS subjects, compared to ...


Effect Of Anthropometric Adjustments On Bmd And Bmc Z-Scores In A Population Of Prader-Willi Syndrome Pediatric Patients, Amanda E. Marker, David F. Short, Talia Eldar-Geva, Harry J. Hirsch, Varda Gross-Tsur, Maayan Tiomkin, Ari Zimran, Thomas N. Hangartner Oct 2014

Effect Of Anthropometric Adjustments On Bmd And Bmc Z-Scores In A Population Of Prader-Willi Syndrome Pediatric Patients, Amanda E. Marker, David F. Short, Talia Eldar-Geva, Harry J. Hirsch, Varda Gross-Tsur, Maayan Tiomkin, Ari Zimran, Thomas N. Hangartner

Biomedical, Industrial & Human Factors Engineering Faculty Publications

Two adjustment models were applied to a dataset of bone-mineral density (BMD) and bone-mineral content (BMC) from dual-energy x-ray absorptiometry (DXA) measurements of pediatric patients with Prader-Willi Syndrome (PWS). One model used weight, height and % body fat (WHF) in the calculation of Z-scores in addition to race, sex and age already included in the standard model. As percent body fat is not always available, a second model with only weight and height was also examined (WH).


A Practical Guide To An Fmri Experiment, Nasser H. Kashou May 2014

A Practical Guide To An Fmri Experiment, Nasser H. Kashou

Biomedical, Industrial & Human Factors Engineering Faculty Publications

Functional Magnetic Resonance Imaging (fMRI) has been around for two decades and research in this field has been exponentially rising. Much of this research has been dominated by basic science. Recent trends have brought the clinical realm into play in which valuable contributions can still be made. Helping the clinician understand the basic concepts behind an fMRI experiment is crucial to further developing and evaluating functional paradigms and research. Critical to designing an fMRI experiment is understanding the related physics and how fine tuning scanning parameters affects the image quality, which in turn affect the findings of an fMRI study ...


Interpolation-Based Super-Resolution Reconstruction: Effects Of Slice Thickness, Amir Pasha Mahmoudzadeh, Nasser H. Kashou Jan 2014

Interpolation-Based Super-Resolution Reconstruction: Effects Of Slice Thickness, Amir Pasha Mahmoudzadeh, Nasser H. Kashou

Biomedical, Industrial & Human Factors Engineering Faculty Publications

Standard clinical magnetic resonance imaging (MRI) is acquired in two-dimensions where the in-plane resolution is higher than the slice select direction. These acquisitions include axial, coronal, and sagittal planes. To date, there have been few attempts to combine the information of these three orthogonal orientations. This paper aims to take advantage of the different in-plane resolution acquired from each plane orientation and combine them into one volume in order to attain a higher resolution image. This combination of MRI data will allow the detection of smaller areas that would otherwise be missed using only one slice orientation. A comparison of ...


Evaluation Of Interpolation Effects On Upsampling And Accuracy Of Cost Functions-Based Optimized Automatic Image Registration, Amir Pasha Mahmoudzadeh, Nasser H. Kashou Jan 2013

Evaluation Of Interpolation Effects On Upsampling And Accuracy Of Cost Functions-Based Optimized Automatic Image Registration, Amir Pasha Mahmoudzadeh, Nasser H. Kashou

Biomedical, Industrial & Human Factors Engineering Faculty Publications

Interpolation has become a default operation in image processing and medical imaging and is one of the important factors in the success of an intensity-based registration method. Interpolation is needed if the fractional unit of motion is not matched and located on the high resolution (HR) grid. The purpose of this work is to present a systematic evaluation of eight standard interpolation techniques (trilinear, nearest neighbor, cubic Lagrangian, quintic Lagrangian, hepatic Lagrangian, windowed Sinc, B-spline 3rd order, and B-spline 4th order) and to compare the effect of cost functions (least squares (LS), normalized mutual information (NMI), normalized cross correlation (NCC ...


Current Trends Of Fmri In Vision Science: A Review, Nasser H. Kashou May 2012

Current Trends Of Fmri In Vision Science: A Review, Nasser H. Kashou

Biomedical, Industrial & Human Factors Engineering Faculty Publications

Studying brain functional activities is an area that is experiencing rapid interest in the field of neuroimaging. Functional magnetic resonance imaging (fMRI) has provided vision science researchers a powerful and noninvasive tool to understand eye function and correlate it with brain activities. In this chapter, we focus on the physiological aspects followed by a literature review. More specifically, to motivate and appreciate the complexity of the visual system, we will begin with a description of specific stages the visual pathway, beginning from the distal stimulus and ending in the visual cortex. More importantly, the development of ascending visual pathway will ...


New Window On Optical Brain Imaging; Medical Development, Simulations And Applications, Chemseddine Mansouri, Nasser H. Kashou Feb 2012

New Window On Optical Brain Imaging; Medical Development, Simulations And Applications, Chemseddine Mansouri, Nasser H. Kashou

Biomedical, Industrial & Human Factors Engineering Faculty Publications

In this chapter we hope to give a technological review of near-infrared light and systems, discuss optode design considerations including background on the fiber design as it relates to this field and finally touch on current trends and applications. For the latter, we will focus on diffusion theory and simulation of photon propagation using a head model. We will follow this with concluding remarks.


Revised Reference Curves For Bone Mineral Content And Areal Bone Mineral Density According To Age And Sex For Black And Non-Black Children: Results Of The Bone Mineral Density In Childhood Study, Babette S. Zemel, Heidi J. Kalkwarf, Vicente Gilsanz, Joan M. Lappe, Sharon Oberfield, John A. Shepherd, Margaret M. Frederick, Xangke Huang, Ming Lu, Soroosh Mahboubi, Thomas N. Hangartner, Karen K. Winer Oct 2011

Revised Reference Curves For Bone Mineral Content And Areal Bone Mineral Density According To Age And Sex For Black And Non-Black Children: Results Of The Bone Mineral Density In Childhood Study, Babette S. Zemel, Heidi J. Kalkwarf, Vicente Gilsanz, Joan M. Lappe, Sharon Oberfield, John A. Shepherd, Margaret M. Frederick, Xangke Huang, Ming Lu, Soroosh Mahboubi, Thomas N. Hangartner, Karen K. Winer

Biomedical, Industrial & Human Factors Engineering Faculty Publications

Context: Deficits in bone acquisition during growth may increase fracture risk. Assessment of bone health during childhood requires appropriate reference values relative to age, sex, and population ancestry to identify bone deficits.

Objective: The objective of this study was to provide revised and extended reference curves for bone mineral content (BMC) and areal bone mineral density (aBMD) in children.

Design: The Bone Mineral Density in Childhood Study was a multicenter longitudinal study with annual assessments for up to 7 yr.

Setting: The study was conducted at five clinical centers in the United States.

Participants: Two thousand fourteen healthy children (992 ...


Reducing Selection Bias In Case-Control Studies From Rare Disease Registries, J. Alexander Cole, John S. Taylor, Thomas N. Hangartner, Neal J. Weinreb, Pramod K. Mistry, Aneal Khan Sep 2011

Reducing Selection Bias In Case-Control Studies From Rare Disease Registries, J. Alexander Cole, John S. Taylor, Thomas N. Hangartner, Neal J. Weinreb, Pramod K. Mistry, Aneal Khan

Biomedical, Industrial & Human Factors Engineering Faculty Publications

Background: In clinical research of rare diseases, where small patient numbers and disease heterogeneity limit study design options, registries are a valuable resource for demographic and outcome information. However, in contrast to prospective, randomized clinical trials, the observational design of registries is prone to introduce selection bias and negatively impact the validity of data analyses. The objective of the study was to demonstrate the utility of case-control matching and the risk-set method in order to control bias in data from a rare disease registry. Data from the International Collaborative Gaucher Group (ICGG) Gaucher Registry were used as an example.

Methods ...


Tracking Of Bone Mass And Density During Childhood And Adolescence, Heidi J. Kalkwarf, Vicente Gilsanz, Joan M. Lappe, Sharon Oberfield, John A. Shepherd, Thomas N. Hangartner, Xangke Huang, Margaret M. Frederick, Karen K. Winer, Babette S. Zemel Apr 2010

Tracking Of Bone Mass And Density During Childhood And Adolescence, Heidi J. Kalkwarf, Vicente Gilsanz, Joan M. Lappe, Sharon Oberfield, John A. Shepherd, Thomas N. Hangartner, Xangke Huang, Margaret M. Frederick, Karen K. Winer, Babette S. Zemel

Biomedical, Industrial & Human Factors Engineering Faculty Publications

Context: Whether a child with low bone mineral density (BMD) at one point in time will continue to have low BMD, despite continued growth and maturation, is important clinically. The stability of a characteristic during growth is referred to as “tracking.”

Objective: We examined the degree of tracking in bone mineral content (BMC) and BMD during childhood and adolescence and investigated whether tracking varied according to age, sexual maturation, and changes in growth status.

Design: We conducted a longitudinal study with measurements at baseline and annually for 3 yr.

Setting: The Bone Mineral Density in Childhood Study was conducted at ...


Height Adjustment In Assessing Dual Energy X-Ray Absorptiometry Measurements Of Bone Mass And Density In Children, Babette S. Zemel, Mary B. Leonard, Andrea Kelly, Joan M. Lappe, Vicente Gilsanz, Sharon Oberfield, Soroosh Mahboubi, John A. Shepherd, Thomas N. Hangartner, Margaret M. Frederick, Karen K. Winer, Heidi J. Kalkwarf Mar 2010

Height Adjustment In Assessing Dual Energy X-Ray Absorptiometry Measurements Of Bone Mass And Density In Children, Babette S. Zemel, Mary B. Leonard, Andrea Kelly, Joan M. Lappe, Vicente Gilsanz, Sharon Oberfield, Soroosh Mahboubi, John A. Shepherd, Thomas N. Hangartner, Margaret M. Frederick, Karen K. Winer, Heidi J. Kalkwarf

Biomedical, Industrial & Human Factors Engineering Faculty Publications

Context: In children, bone mineral content (BMC) and bone mineral density (BMD) measurements by dual-energy x-ray absorptiometry (DXA) are affected by height status. No consensus exists on how to adjust BMC or BMD (BMC/BMD) measurements for short or tall stature.

Objective: The aim of this study was to compare various methods to adjust BMC/BMD for height in healthy children.

Design: Data from the Bone Mineral Density in Childhood Study (BMDCS) were used to develop adjustment methods that were validated using an independent cross-sectional sample of healthy children from the Reference Data Project (RDP).

Setting: We conducted the study ...


Distribution Tridimensionnelle De La Lumière Dans Une Strucutre De Tête D’Adulte Dérivée D’Un Acte Irm: Approche Par La Méthode De Monte Carlo, Chemseddine Mansouri, Jean-Pierre L'Huillier, Nasser H. Kashou May 2009

Distribution Tridimensionnelle De La Lumière Dans Une Strucutre De Tête D’Adulte Dérivée D’Un Acte Irm: Approche Par La Méthode De Monte Carlo, Chemseddine Mansouri, Jean-Pierre L'Huillier, Nasser H. Kashou

Biomedical, Industrial & Human Factors Engineering Faculty Publications

No abstract provided.


Detection Of Aortic Calcification During Vertebral Fracture Assessment (Vfa) Compared To Digital Radiography, John T. Schousboe, Kevin E. Wilson, Thomas N. Hangartner Aug 2007

Detection Of Aortic Calcification During Vertebral Fracture Assessment (Vfa) Compared To Digital Radiography, John T. Schousboe, Kevin E. Wilson, Thomas N. Hangartner

Biomedical, Industrial & Human Factors Engineering Faculty Publications

Background: Cardiovascular disease is the most common cause of mortality among post-menopausal women. Our objective was to determine whether or not lateral spine images obtained on a bone densitometer to detect prevalent vertebral fracture can also accurately detect radiographic abdominal aortic calcification (AAC), an important risk factor for cardiovascular disease independent of clinical risk factors.

Methodology/Principal Findings: One hundred seventy four postmenopausal women had bone densitometry, lateral spine densitometry imaging (called vertebral fracture assessment, or VFA), and lateral spine digital radiographs. Radiographs and VFA images were scored for AAC using a previously validated 24 point scale and a simplified ...