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Purpose: Periprosthetic joint infections (PJIs) are a very demanding complication of arthroplasty. Diagnosis of PJI and pathogen identification pose considerable challenges in clinical practice. We hypothesized that the pathogen-specific immune response to PJI reflects the infection process, provides clinically relevant information on disease course, and has the potential to further optimize antimicrobial therapy. Methods: We conducted a prospective matched cohort pilot study with 13 patients undergoing two-stage septic revision arthroplasty (PJI patients) between 06/2020 and 06/2021, as well as 11 control patients undergoing one-stage aseptic revision arthroplasty (Non-PJI patients). Pre-, intra- and postoperative serum samples were collected at standardized time points. We developed a custom Luminex®-based quantitative bead-based suspension array (Infection Array; IA), and used it for simultaneous measurement of antibody specificities against 32 pathogens commonly associated with PJI in 267 serum samples. Results: The IA was able to trace the dynamics of the pathogen-specific humoral immune response in all patients against PJI-related pathogens, prominently coagulase-negative staphylococci and streptococci. Pathogen-specific serum antibody titers declined in 62% of PJI patients over the course of treatment, while no changes in antibody titers were observed in 82% of Non-PJI patients during this study. Our serological data strongly suggested that antibody signatures reflect an immune response to microbial invasion. Conclusion: Our results provide insights into the pathophysiology of PJI and information on the individual disease courses. The IA is therefore a promising and novel serological tool of high resolution for monitoring the immunoproteomic footprints of infectious pathogens in the course of PJI. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the present study is to develop a calibration method to account for differences in echo times (TE) and facilitate the use of restriction spectrum imaging restriction score (RSIrs) as a quantitative biomarker for the detection of clinically significant prostate cancer (csPCa). Methods: This study included 197 consecutive patients who underwent MRI and biopsy examination; 97 were diagnosed with csPCa (grade group ≥ 2). RSI data were acquired three times during the same session: twice at minimum TE ~75 ms and once at TE = 90 ms (TEmin1, TEmin2, and TE90, respectively). A linear regression model was determined to match the C‐maps of TE90 to the reference C‐maps of TEmin1 within the interval ranging from 95th to 99th percentile of signal intensity within the prostate. RSIrs comparisons were made at the 98th percentile within each patient's prostate. We compared RSIrs from calibrated TE90 (RSIrsTE90corr) and uncorrected TE90 (RSIrsTE90) to RSIrs from reference TEmin1 (RSIrsTEmin1) and repeated TEmin2 (RSIrsTEmin2). Calibration performance was evaluated with sensitivity, specificity and area under the ROC curve (AUC). Results: Scaling factors for C1, C2, C3, and C4 were estimated as 1.68, 1.33, 1.02, and 1.13, respectively. In non‐csPCa cases, the 98th percentile of RSIrsTEmin2 and RSIrsTEmin1 differed by 0.27 ± 0.86SI (mean ± standard deviation), whereas RSIrsTE90 differed from RSIrsTEmin1 by 1.82 ± 1.20SI. After calibration, this bias was reduced to ‐0.51 ± 1.21SI, representing a 72% reduction in absolute error. For patients with csPCa, the difference was 0.54 ± 1.98SI between RSIrsTEmin2 and RSIrsTEmin1 and 2.28 ± 2.06SI between RSIrsTE90 and RSIrsTEmin1. After calibration, the mean difference decreased to ‐1.03SI, a 55% reduction in absolute error. At the Youden index for patient‐level classification of csPCa (8.94SI), RSIrsTEmin1 has a sensitivity of 66% and a specificity of 72%. Conclusions: The proposed linear calibration method produces similar quantitative biomarker values for acquisitions with different TE, reducing TE‐induced error by 72% and 55% for non‐csPCa and csPCa, respectively. [ABSTRACT FROM AUTHOR]

Background: In breast diffusion‐weighted imaging (DWI), distortion and physiologic artifacts affect clinical interpretation. Image quality can be optimized by addressing the effect of phase encoding (PE) direction on these artifacts. Purpose: To compare distortion artifacts in breast DWI acquired with different PE directions and polarities, and to discuss their clinical implications. Study Type: Prospective. Population: Eleven healthy volunteers (median age: 47 years old; range: 22–74 years old) and a breast phantom. Field Strength/Sequence: Single‐shot echo planar DWI and three‐dimensional fast gradient echo sequences at 3 T. Assessment: All DWI data were acquired with left–right, right–left, posterior–anterior, and anterior–posterior PE directions. In phantom data, displacement magnitude was evaluated by comparing the location of landmarks in anatomical and DWI images. Three breast radiologists (5, 17, and 23 years of experience) assessed the presence or absence of physiologic artifacts in volunteers' DWI datasets and indicated their PE‐direction preference. Statistical Tests: Analysis of variance with post‐hoc tests were used to assess differences in displacement magnitude across DWI datasets and observers. A binomial test and a chi‐squared test were used to evaluate if each in vivo DWI dataset had an equal probability (25%) of being preferred by radiologists. Inter‐reader agreement was evaluated using Gwet's AC1 agreement coefficient. A P‐value <0.05 was considered statistically significant. Results: In the phantom study, median displacement was the significantly largest in posterior–anterior data. While the displacement in the anterior–posterior and left–right data were equivalent (P = 0.545). In the in vivo data, there were no physiological artifacts observed in any dataset, regardless of PE direction. In the reader study, there was a significant preference for the posterior–anterior datasets which were selected 94% of the time. There was good agreement between readers (0.936). Data Conclusion: This study showed the impact of PE direction on distortion artifacts in breast DWI. In healthy volunteers, the posterior‐to‐anterior PE direction was preferred by readers. Level of Evidence: 2 Technical Efficacy: Stage 1 [ABSTRACT FROM AUTHOR]

The diagnosis of a common cause of chronic pelvic pain can be made by visualizing reflux in the ovarian veins. Fluoroscopic venography is the gold standard for diagnosing ovarian vein reflux, but it is an invasive technique that exposes patients to ionizing radiation. MRI, with its lack of ionizing radiation and capability of high-temporal and spatial-resolution vascular imaging, has the potential to provide similar diagnostic information. This retrospective report describes and assesses the utility of a dynamic contrast-enhanced MRI technique based on Differential Subsampling with Cartesian Ordering (DISCO)–MRI in 30 patients with chronic pelvic pain. Among the 14 patients who underwent both DISCO–MRI and fluoroscopic venograms, 11 (78.6%) exhibited concordant results, while 3 patients (21.4%) had discordant findings. These results suggest the potential of multiphasic contrast-enhanced DISCO–MRI as a non-invasive diagnostic tool for evaluating chronic pelvic pain. [ABSTRACT FROM AUTHOR]

In addition to their food security and ecological benefits, urban community gardens support human well-being in numerous non-material ways. In this paper, we investigate whether experience of these cultural ecosystem services (CES) shapes how gardeners choose to manage the garden ecosystem, which may influence the ability of these multifunctional green spaces to provide other local ecosystem services (ES). Using questionnaires, in-depth interviews, and plant community analysis, we assess the relationship between perception of CES by community gardeners, the management practices they utilize, and the agroecological characteristics of their garden plots, such as presence and prevalence of species that provide regulating and supporting ES. We find that while almost all survey participants report sociocultural benefits of gardening, experience of these CES varies significantly between gardeners, with garden structure influencing which group of benefits is most perceived. Experience of some CES was also correlated with local ecological knowledge and use of certain sustainable garden management practices, such as utilizing integrated pest management strategies and planting a wide variety of species, but not with observed non-provisioning plant agrobiodiversity. These results provide important insights into the complex role that CES play in encouraging environmental stewardship and shaping ecological outcomes in collectively managed urban green spaces. [ABSTRACT FROM AUTHOR]

Introduction: Simulation-based training (SBT) aids healthcare providers in acquiring the technical skills necessary to improve patient outcomes and safety. However, since SBT may require significant resources, training all skills to a comparable extent is impractical. Hence, a strategic prioritization of technical skills is necessary. While the European Training Requirements in Neonatology provide guidance on necessary skills, they lack prioritization. We aimed to identify and prioritize technical skills for a SBT curriculum in neonatology. Methods: A three-round modified Delphi process of expert neonatologists and neonatal trainees was performed. In round one, the participants listed all the technical skills newly trained neonatologists should master. The content analysis excluded duplicates and non-technical skills. In round two, the Copenhagen Academy for Medical Education and Simulation Needs Assessment Formula (CAMES-NAF) was used to preliminarily prioritize the technical skills according to frequency, importance of competency, SBT impact on patient safety, and feasibility for SBT. In round three, the participants further refined and reprioritized the technical skills. Items achieving consensus (agreement of ≥75%) were included. Results: We included 168 participants from 10 European countries. The response rates in rounds two and three were 80% (135/168) and 87% (117/135), respectively. In round one, the participants suggested 1964 different items. Content analysis revealed 81 unique technical skills prioritized in round two. In round three, 39 technical skills achieved consensus and were included. Conclusion: We reached a European consensus on a prioritized list of 39 technical skills to be included in a SBT curriculum in neonatology. [ABSTRACT FROM AUTHOR]

Simple Summary: This article reviews the value of Positron Emission Tomography/Magnetic Resonance Imaging (PET/MRI) in evaluating female pelvic cancers. It also provides a comparative analysis of PET/MRI with other imaging modalities in the context of female pelvic malignancies and outlines their respective strengths and limitations. The aim of this narrative review is to introduce to clinicians up and coming technology and how it may be valuable to their assessment of female pelvic cancers. The diagnosis, treatment, and management of gynecologic malignancies benefit from both positron emission tomography/computed tomography (PET/CT) and MRI. PET/CT provides important information on the local extent of disease as well as diffuse metastatic involvement. MRI offers soft tissue delineation and loco-regional disease involvement. The combination of these two technologies is key in diagnosis, treatment planning, and evaluating treatment response in gynecological malignancies. This review aims to assess the performance of PET/MRI in gynecologic cancer patients and outlines the technical challenges and clinical advantages of PET/MR systems when specifically applied to gynecologic malignancies. [ABSTRACT FROM AUTHOR]

Spending time in nature during childhood can improve mental and physical health, support academic success, and cultivate pro-environmental attitudes and behaviors. Increasing outdoor time during school can enhance the likelihood of those outcomes for all students. However, in practice incorporating outdoor time into the school day can be challenging. This study reports on barriers identified during the development phase of an action research project that aimed to increase outdoor time as a regular, repeated part of the elementary school day. Teachers (n = 22) and administrators (n = 3) in one school district in the Northeastern United States were asked to describe the barriers that limited their opportunities to take students outside. Data indicated 33 discrete barriers and 5 themes that cut across the barriers. Interactions and overlap across barriers increased the challenges encountered by teachers. A systems thinking approach is suggested to increase outdoor time in schools. [ABSTRACT FROM AUTHOR]

Background: Bone marrow-derived mesenchymal stromal cells (BM-MSCs) are used in regenerative medicine and related research involving immunomodulatory, anti-inflammatory, anti-fibrotic and regenerative functions. Isolation of BM-MSCs from samples obtained during total hip arthroplasty (THA) is routinely possible. Advanced age and comorbidities of the majority of patients undergoing THA limit their applicability. Our study aimed to evaluate the potential of bone marrow obtained during periacetabular osteotomy (PAO) as a novel source of BM-MSCs from young donors by analyzing cell yield and cell characteristics. Methods: Bone samples were obtained from the anterior Os ilium or superior Os pubis during PAO and from the femoral cavity during primary THA. Isolation of bone marrow-derived mononuclear cells (BM-MNCs) was performed by density gradient centrifugation. The samples from PAO and THA patients were compared in terms of BM-MSC yield, colony formation and the proportion of BM-MSCs within the BM-MNC population using flow cytometry analysis. The cells were characterized based on the expression of BM-MSC-specific surface markers. The functionality of the cells was compared by quantifying post-thaw viability, metabolic activity, proliferation capacity, senescence-associated beta galactosidase (SA-β-gal) expression, trilineage differentiation potential and major secretome proteins. Results: Isolation of BM-MNCs was possible in a reliable and reproducible manner when using bone from PAO containing more than 0.24 g bone marrow. PAO patients were younger than patients of the THA group. Bone obtained during PAO contained less bone marrow and led to a lower BM-MSC number after the first cell culture passage compared to BM-MSCs obtained during THA. BM-MSCs from PAO samples are characterized by a higher proliferation capacity. This results in a higher yield in cell culture passage two, when normalized to the sample weight. BM-MSCs from PAO patients showed increased secretion of TGF-β1, TIMP2, and VEGF upon osteogenic differentiation. BM-MSCs from PAO and THA patients revealed similar results regarding the onset of SA-β-gal expression and trilineage differentiation capacity. Conclusions: We suggest that bone obtained during PAO is a promising novel source for BM-MSCs from young donors. Limited absolute cell yield due to low sample weight must be considered in early cell culture passages and might be critical for the range of clinical applications possible for BM-MSCs from this source. The higher proliferation capacity and increased growth factor secretion of BM-MSCs from young donors may be beneficial for future regenerative cell therapies, in vitro models, and tissue engineering. [ABSTRACT FROM AUTHOR]

There is increasing pressure within universities to address student mental health. From a whole university or settings-based perspective, this could include curriculum-embedded approaches. There is little research about how this should work or what approaches might be most effective. Semi -structured interviews were conducted with fifty-seven undergraduate students from five disciplines (Psychology, English studies, Nursing, International Politics, and War Studies) to understand students' perspectives. Students reflected on wellbeing module content and, more broadly, on curriculum processes (teaching, pedagogy, assessment) within their degree. Reflexive thematic analysis was applied to transcripts, generating three themes: embedding wellbeing in the curriculum; assessment, challenge, and academic support; and social connection and interaction. The findings provide evidence for teaching, pedagogy, and assessment practices supporting higher education student wellbeing. These align with recommended good teaching practices, such as considering appropriate assessment methods followed by effective feedback. Students saw the benefits of being academically challenged if scaffolded appropriately. Strong peer connection, teacher-student interaction, and communication were crucial to learning and wellbeing. These findings provide implications for future curriculum design that can support learning and wellbeing. [ABSTRACT FROM AUTHOR]

Purpose: Dynamic contrast-enhanced MRI (DCE) and apparent diffusion coefficient (ADC) are currently used to evaluate treatment response of breast cancer. The purpose of the current study was to evaluate the three-component Restriction Spectrum Imaging model (RSI3C), a recent diffusion-weighted MRI (DWI)-based tumor classification method, combined with elastic image registration, to automatically monitor breast tumor size throughout neoadjuvant therapy. Experimental design: Breast cancer patients (n=27) underwent multi-parametric 3T MRI at four time points during treatment. Elastically-registered DWI images were used to generate an automatic RSI3C response classifier, assessed against manual DCE tumor size measurements and mean ADC values. Predictions of therapy response during treatment and residual tumor post-treatment were assessed using non-pathological complete response (non-pCR) as an endpoint. Results: Ten patients experienced pCR. Prediction of non-pCR using ROC AUC (95% CI) for change in measured tumor size from pre-treatment time point to early-treatment time point was 0.65 (0.38-0.92) for the RSI3C classifier, 0.64 (0.36-0.91) for DCE, and 0.45 (0.16-0.75) for change in mean ADC. Sensitivity for detection of residual disease post-treatment was 0.71 (0.44-0.90) for the RSI3C classifier, compared to 0.88 (0.64-0.99) for DCE and 0.76 (0.50-0.93) for ADC. Specificity was 0.90 (0.56-1.00) for the RSI3C classifier, 0.70 (0.35-0.93) for DCE, and 0.50 (0.19-0.81) for ADC. [ABSTRACT FROM AUTHOR]

Introduction: The Somatic Marker Hypothesis (SMH) posits that in experience- based choice, people develop physiological reactions that mark options as either positive or negative. These somatic markers aid decision making because they differentiate between “good” and “bad” options during pre-choice deliberation. Methods: We examined this proposed role for somatic states in two decision- from-experience tasks (each N = 36) in which participants selected repeatedly with full feedback (i.e., for obtained and forgone outcomes) between two unlabeled options that returned wins or losses, with half receiving an additional summary of past outcomes. The probabilities of good and bad outcomes changed at an unannounced point. Participants completed a 100-trial game with a switch in the optimal option after trial 40 (Study 1) or a 200-trial game with switch points after trial 40 and trial 120 (Study 2). Skin conductance (SC) was measured continuously as an index of emotional intensity, from which we extracted measures of anticipatory SC (pre-choice) and outcome SC (post-choice). Results: Participants reliably selected the optimal option prior to any switches. They also altered their choices appropriately when the payoffs changed, though optimal play following payoff switches was reduced. Losses resulted in a greater outcome SC than wins, but only in Study 1, as did the finding that the outcome SC was greater when the forgone outcome was positive. Anticipatory SC did not reliably predict optimal play in either study. Discussion: These results provide little support for the SMH. Our studies point to the importance of using diverse tasks and measures and very large sample sizes when testing the role of somatic states in decision making. [ABSTRACT FROM AUTHOR]

Concerns about university students' mental wellbeing have been rising and various studies have attempted to unpick the factors that could impact their wellbeing. This focus group study explored the impact that virtual learning environments (VLEs) may have on undergraduate students' mental wellbeing. Forty-four undergraduate students from on-campus courses at three UK universities participated in 12 focus groups in 2020. Using reflexive thematic analysis with an inductive approach, three themes were generated: (1) lecturer VLE-use supports or undermines students' mental wellbeing; (2) access to the VLE affects students' productivity, academic performance, and mental wellbeing; and (3) students' mindset towards the VLE impacts their studies and mental wellbeing. The dominant pattern across the data set was that the way lecturers used the VLE impacted students' motivation, ability to think clearly about their studies, and could provoke strong emotions. We discuss how the mechanisms described in self-determination theory and the technology acceptance model might explain how the VLE could impact student mental wellbeing. [ABSTRACT FROM AUTHOR]

Objective: To seek to find a way to address stress and build social bonds among U.S. college students, an East Coast private institution and a West Coast state institution each offered an undergraduate Nature Rx course. Participants: Seventeen undergraduate students were enrolled in the West Coast state institution seminar, and sixteen undergraduate students were enrolled in the East Coast private institution seminar. Methods: A mixed methods approach was used to evaluate the effectiveness of the pilot such that students were given pre- and post-course questionnaires and asked to write reflective essays to describe their experiences in the class. Results: While no significant changes in self-perceived stress were reported in questionnaire items, the qualitative data indicated students attributed their participation in the course with factors that contributed to reduced stress and important social connections. These included a strengthened belief in the value of spending time in nature to reduce stress, the creation and solidification of social bonds, and an expectation that the class would have a lasting impact. Conclusion: Overall, participants indicated they experienced frequent and meaningful interactions with other students and the instructors while gaining greater familiarity with the natural elements of their respective campuses. [ABSTRACT FROM AUTHOR]

Introduction: The aim was to determine risk factors among mothers and outcomes for their children born at the limit of viability in 2009–2019, before and after the introduction of extended interventionist guidelines. Methods: A retrospective cohort study of births at 22 + 0–23 + 6 gestational weeks in a Swedish Region in 2009–2015 (n = 119), as compared to 2016–2019 (n = 86) after the introduction of new national interventionist guidelines. Infant mortality, morbidity, and cognitive functions at 2 years corrected age according to the Bayley-III Screening Test were monitored. Results: Maternal risk factors for extreme preterm birth were identified. The intrauterine fetal death rates were comparable. Among births at 22 weeks, the neonatal mortality tended to decrease (96 vs. 76% of live births (p = 0.05)), and the 2-year survival tended to increase (4 vs. 24% (p = 0.05)). Among births at 23 weeks, the neonatal mortality decreased (56 vs. 27% of live births (p = 0.01)), and the 2-year survival increased (42 vs. 64% (p = 0.03)). Somatic morbidity and cognitive disability at 2 years corrected age were unchanged. Conclusion: We identified maternal risk factors that emphasize the need for standardized follow-up and counseling for women at increased risk of preterm birth at the limit of viability. The increased infant survival concomitant with unchanged morbidity and cognitive disability highlight the importance of ethical considerations regarding interventionist approaches at threatening preterm birth before 24 weeks. [ABSTRACT FROM AUTHOR]

Breast cancer is the most common malignancy in women, and for women under 40, it is the leading cause of cancer-related deaths. A specific type of breast cancer is pregnancy-associated breast cancer, which is diagnosed during pregnancy, the first-year postpartum, or during lactation. Pregnancy-associated breast cancer is seen in 3/1000 pregnancies and is increasing in incidence as women delay pregnancy. This type of breast cancer is more aggressive, and not infrequently, there is a delay in diagnosis attributed to physiologic changes that occur during pregnancy and a lack of awareness among physicians. In this review, we discuss the demographics of pregnancy-associated breast cancer, provide differential considerations, and illustrate the multimodality imaging features to bring attention to the radiologist about this aggressive form of breast cancer. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study is to evaluate the clinical and radiological results of cervical disc arthroplasty (CDA) in patients with cervical spondylotic myelopathy (CSM) using the CP ESP® disc prosthesis. Materials and Methods: Prospectively collected data of 56 patients with CSM have been analyzed. The mean age at surgery was 35.6 years (range: 25–43 years). The mean follow-up was 28.2 months (range: 13–42 months). The range of motion (ROM) of the index segments, as well as upper and lower adjacent segments, was measured before surgery and at final follow-up. The C2-C7 sagittal vertical axis (SVA), C2-C7 cervical lordosis (CL), and T1 slope minus cervical lordosis (T1s-CL) were analyzed as well. Pain intensity was measured preoperatively and during follow-up using an 11-point numeric rating scale (NRS). Modified Japanese Orthopaedic Association (mJOA) score was assessed preoperatively and during follow-up for the clinical assessment of myelopathy. Surgical and implant-associated complications were analyzed as well. Results: The NRS pain score improved from a mean of 7.4 (±1.1) preoperatively to a mean of 1.5 (±0.7) at last follow-up (p < 0.001). The mJOA score improved from a mean of 13.1 (±2.8) preoperatively to a mean of 14.8 (±2.3) at last follow-up (p < 0.001). The mean ROM of the index levels increased from 5.2° (±3.0) preoperatively to 7.3° (±3.2) at last follow-up (p < 0.05). Four patients developed heterotopic ossifications during follow-up. One patient developed permanent dysphonia. Conclusions: CDA showed good clinical and radiological outcome in this cohort of young patients. The motion of index segments could be preserved. CDA may be a viable treatment option in selected patients with CSM. [ABSTRACT FROM AUTHOR]

Copyright of Die Orthopädie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: To date, the accuracy and variability of diffusion‐weighted MRI (DW‐MRI) metrics have been reported in a limited number of scanner/protocol/coil combinations. Purpose: To evaluate the reproducibility of DW‐MRI estimates across multiple scanners and DW‐MRI protocols and to assess the effects of using an 8‐channel vs. 16‐channel breast coil in a breast phantom. Study Type: Prospective. Phantom: Breast phantom containing tubes of water and differing polyvinylpyrrolidone (PVP) concentrations with apparent diffusion coefficients (ADCs) matching breast tissue. Field Strength/Sequence: 3 T (three standard and one wide bore), three DW‐MRI single‐shot echo planar imaging protocols of varying acquired spatial resolution. Assessment: Accuracy of estimated ADCs was assessed using percent differences (PD) relative to nuclear magnetic resonance spectroscopy‐derived reference values. Coefficients of variation (CV) were calculated to determine variation across scanners. CVs based on the median standard deviation (CVM) were used to evaluate tube‐specific dispersion using 8‐ or 16‐channel coils at a single scanner. ADCs of PVP‐containing tubes were additionally normalized by the median water tube ADC to account for temperature effects. Statistical Tests: Two‐way repeated measures analysis of variance and post hoc tests were used to evaluate differences in ADC, CV, and CVM across scanners and protocols (α = 0.05). Results: ADCs were within 11% (interquartile range [IQR] 7%) of reference values and significantly improved to 2% (IQR 7%) after normalization to an internal water reference. Normalization significantly reduced interscanner variability of ADC estimates from 7% to 4%. DW‐MRI protocol did not affect ADC accuracy; however, the clinical and higher‐resolution clinical protocols resulted in the greatest (9%) and least (6%) interscanner variability, respectively. The 8‐ and 16‐channel receive coils yielded similar accuracy (PD: 12% vs. 16%) and precision (CVM: 2.7% vs. 2.9%). Data Conclusion: Normalization by an internal reference improved interscanner ADC reproducibility. High‐resolution protocols yielded comparably accurate and significantly less variable ADCs compared to a clinical standard protocol. Evidence Level: 2 Technical Efficacy: Stage 1 [ABSTRACT FROM AUTHOR]

Affect can influence judgments of event riskiness and use of risk‐related information. Two studies (Ns: 85 and 100) examined the insensitivity‐to‐probability effect—where people discount probability information when scenarios are affect‐rich—applying it to evidence‐informed risk communication. We additionally investigated whether this effect is moderated by format, based on predictions from the evaluability and pattern‐recognition literatures, suggesting that graphical formats may attenuate insensitivity to probability. Participants completed a prior beliefs questionnaire (Study 1), and risk perception booklet (both studies) that presented identical statistical information about the relative risks associated with two scenarios—one with an affect‐rich outcome, the other an affect‐poorer outcome. In Study 1, this was presented graphically. In Study 2, information was presented in one of three formats: written, tabular, or graphical. Participants provided their perceptions of the risk for each scenario at a range of risk‐levels. The affect‐rich scenario was perceived as higher in risk, and, importantly, despite presenting identical relative risk information in both scenarios, was associated with a reduced sensitivity to probability information (both studies). These differences were predicted by participants' prior beliefs concerning the scenario events (Study 1) and were larger for the single‐item written format than graphical format (Study 2). The findings illustrate that insensitivity to probability information can occur in evidence‐informed risk communications and highlight how communication format can moderate this effect. This interplay between affect and format therefore reflects an important consideration for information designers and researchers. [ABSTRACT FROM AUTHOR]

While probiotics are reported to reduce the risks of neonatal morbidities, less is known about probiotics and feeding tolerance. With this retrospective cohort study, we investigate whether introduction of probiotic supplementation as the standard of care was associated with fewer neonatal morbidities and improved feeding tolerance in very preterm infants. Using the Swedish Neonatal Quality Register, 345 live-born very preterm infants (28–31 weeks' gestation), from January 2019–August 2021, in NICUs in Stockholm, Sweden, either received probiotic supplementation (Bifidobacterium infantis, Bifidobacterium lactis, Streptococcusthermophilus) (139) or no supplementation (206); they were compared regarding a primary composite outcome of death, sepsis, and/or necrotising enterocolitis and secondary outcomes: time to full enteral feeding and antibiotics use. Probiotics seemed associated with a reduced risk of the composite outcome (4.3% versus 9.2%, p = 0.08). In the subgroup of 320 infants without the primary outcome, probiotics were associated with shorter time to full enteral feeding (6.6 days versus 7.2 days) and less use of antibiotics (5.2 days versus 6.1 days). Our findings suggest that probiotics improve feeding tolerance and further support that very preterm infants may benefit from probiotic supplementation. [ABSTRACT FROM AUTHOR]

Aim: To describe survival and neonatal morbidities in infants born before 24 weeks of gestation during a 12‐year period. Methods: Data were retrieved from national registries and validated in medical files of infants born before 24 weeks of gestation 2007–2018 in Sweden. Temporal changes were evaluated. Results: In 2007–2018, 282 live births were recorded at 22 weeks and 460 at 23 weeks of gestation. Survival to discharge from hospital of infants born alive at 22 and 23 weeks increased from 20% to 38% (p = 0.006) and from 45% to 67% (p < 0.001) respectively. Caesarean section increased from 12% to 22% (p = 0.038) for infants born at 22 weeks. Neonatal morbidity rates in infants alive at 40 weeks of postmenstrual age (n = 399) were unchanged except for an increase in necrotising enterocolitis from 0 to 33% (p = 0.017) in infants born at 22 weeks of gestation. Bronchopulmonary dysplasia was more common in boys than girls, 90% versus 82% (p = 0.044). The number of infants surviving to 40 weeks doubled over time. Conclusion: Increased survival of infants born before 24 weeks of gestation resulted in increasing numbers of very immature infants with severe neonatal morbidities likely to have a negative impact on long‐term outcome. [ABSTRACT FROM AUTHOR]

Copyright of Operative Orthopädie und Traumatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Work-related stress is of growing concern to employers because of its significant implications for employee dissatisfaction, reduced productivity, and lowered emotional and physical health. Job-related stress is particularly acute among staff members in higher education, negatively impacting the professional work and personal welfare of staff. During the COVID-19 pandemic, stress levels increased, due to workand non-work-related factors. Work expectations and environments shifted, as did new non-work responsibilities, such as care of dependents. As a result, many people were forced to spend much more time at home. Given the anticipated levels of stress (higher) and the change in time spent at home (increased), we sought to explore if adults were spending more time outdoors, as compared to pre-pandemic times, and if so, for what purposes. We hypothesized that people would be spending more time outdoors in nature during the pandemic, and that they would be doing so to achieve some of the well-documented benefits including managing stress, and bolstering mental health and wellbeing. We further hypothesized that some staff would experience barriers to spending time outdoors in natural outdoor environments (NOEs), potentially limiting their ability to experience these beneficial effects. Materials and Methods: This study surveyed 507 staff from a large United States university to examine the degree to which staff were spending time in natural outdoor environments (NOEs) during the pandemic (two time-points, compared to prepandemic), and whether and how nature-based routines changed as a result of its emergence. The study also examined whether staff were motivated to spend time in nature to improve their mental health and/or wellbeing. Results: The majority of respondents reported spending more time in NOEs since COVID-19 emerged, particularly early in the pandemic. Respondents reported doing so for restorative purposes, including stress relief, improved mental health, and improved physical health. Relative accessibility of NOEs, both in terms of proximity and number of barriers to access, significantly impacted both time outdoors and the number of NOEs used. Access to safe, high-quality NOEs was not experienced equally across staff respondents; barriers to access tended to be higher among staff living with dependents or others in their household, and for staff who identify as non-White. Conclusion: Spending time outdoors may have served as a protective factor for many university staff against some of the potentially detrimental effects of the pandemic, particularly reduced mental health and well-being. Universities can contribute to the ongoing well-being of their staff by supporting access to safe, high-quality NOEs on or adjacent to campus. This may also serve to reduce disparities in access to nature and experience of its benefits. Universities may also consider alternative work arrangements for staff to allow for more time for health and wellness self-care during the work day, including spending time outdoors in nature. [ABSTRACT FROM AUTHOR]

The role of diffusion weighted imaging (DWI) as a biomarker has been the subject of active investigation in the field of breast radiology. By quantifying the random motion of water within a voxel of tissue, DWI provides indirect metrics that reveal cellularity and architectural features. Studies show that data obtained from DWI may provide information related to the characterization, prognosis, and treatment response of breast cancer. The incorporation of DWI in breast imaging demonstrates its potential to serve as a non-invasive tool to help guide diagnosis and treatment. In this review, current technical literature of diffusion-weighted breast imaging will be discussed, in addition to clinical applications, advanced techniques, and emerging use in the field of radiomics. [ABSTRACT FROM AUTHOR]

This article describes Dr. Murray Bowen's original research from which the concept of differentiation of self emerged. Bowen's extension of the concept ultimately developed into the science of human behavior now known as Bowen theory. The descriptions here are taken from materials in the Bowen archives at the National Library of Medicine and from the Bowen family materials in Williamsburg, Virginia. Late in his life, when Bowen was drafting his 1988 epilogue "An Odyssey Toward Science" for the book Family Evaluation, he did a thorough review of the earliest periods of the development of his theory. These notes, along with his papers going back fifty years, are now in the archival collection at the National Library of Medicine. Bowen's review, coupled with the actual works from that time, offers a solid opportunity to document his path toward a theory that would extend Freudian theory to integrate more closely with breakthroughs in other sciences. While he maintained a respect for Freud's efforts, when the data supported an alternative theory, Bowen went with the data. This article describes this process, especially with regard to the origin of his concept of differentiation of self, and illuminates the value of the Bowen archives for understanding how the theory originated. [ABSTRACT FROM AUTHOR]

Simple Summary: Women at high risk for breast cancer are regularly screened using contrast-enhanced magnetic resonance imaging (MRI) to identify potential malignancy. Diffusion-weighted MRI (DW-MRI) is a non-contrast technique that measures the differential movement of water molecules in tissues and is sensitive to cancer cells. In this study, we use a multi-exponential advanced DW-MRI model called restriction spectrum imaging (RSI) to characterize the diffusion characteristics of malignant lesions, benign lesions, and healthy breast tissue to help differentiate benign from malignant disease. In a cohort of patients, we show that cancer exhibits more restricted diffusion compared to benign breast lesions and healthy tissue, whereas benign and healthy tissue are not different from each other. Diffusion-weighted MRI (DW-MRI) offers a potential adjunct to dynamic contrast-enhanced MRI to discriminate benign from malignant breast lesions by yielding quantitative information about tissue microstructure. Multi-component modeling of the DW-MRI signal over an extended b-value range (up to 3000 s/mm2) theoretically isolates the slowly diffusing (restricted) water component in tissues. Previously, a three-component restriction spectrum imaging (RSI) model demonstrated the ability to distinguish malignant lesions from healthy breast tissue. We further evaluated the utility of this three-component model to differentiate malignant from benign lesions and healthy tissue in 12 patients with known malignancy and synchronous pathology-proven benign lesions. The signal contributions from three distinct diffusion compartments were measured to generate parametric maps corresponding to diffusivity on a voxel-wise basis. The three-component model discriminated malignant from benign and healthy tissue, particularly using the restricted diffusion C1 compartment and product of the restricted and intermediate diffusion compartments (C1 and C2). However, benign lesions and healthy tissue did not significantly differ in diffusion characteristics. Quantitative discrimination of these three tissue types (malignant, benign, and healthy) in non-pre-defined lesions may enhance the clinical utility of DW-MRI in reducing excessive biopsies and aiding in surveillance and surgical evaluation without repeated exposure to gadolinium contrast. [ABSTRACT FROM AUTHOR]

Background: Multicompartmental modeling outperforms conventional diffusion-weighted imaging (DWI) in the assessment of prostate cancer. Optimized multicompartmental models could further improve the detection and characterization of prostate cancer.Purpose: To optimize multicompartmental signal models and apply them to study diffusion in normal and cancerous prostate tissue in vivo.Study Type: Retrospective.Subjects: Forty-six patients who underwent MRI examination for suspected prostate cancer; 23 had prostate cancer and 23 had no detectable cancer.Field Strength/sequence: 3T multishell diffusion-weighted sequence.Assessment: Multicompartmental models with 2-5 tissue compartments were fit to DWI data from the prostate to determine optimal compartmental apparent diffusion coefficients (ADCs). These ADCs were used to compute signal contributions from the different compartments. The Bayesian Information Criterion (BIC) and model-fitting residuals were calculated to quantify model complexity and goodness-of-fit. Tumor contrast-to-noise ratio (CNR) and tumor-to-background signal intensity ratio (SIR) were computed for conventional DWI and multicompartmental signal-contribution maps.Statistical Tests: Analysis of variance (ANOVA) and two-sample t-tests (α = 0.05) were used to compare fitting residuals between prostate regions and between multicompartmental models. T-tests (α = 0.05) were also used to assess differences in compartmental signal-fraction between tissue types and CNR/SIR between conventional DWI and multicompartmental models.Results: The lowest BIC was observed from the 4-compartment model, with optimal ADCs of 5.2e-4, 1.9e-3, 3.0e-3, and >3.0e-2 mm2 /sec. Fitting residuals from multicompartmental models were significantly lower than from conventional ADC mapping (P < 0.05). Residuals were lowest in the peripheral zone and highest in tumors. Tumor tissue showed the largest reduction in fitting residual by increasing model order. Tumors had a greater proportion of signal from compartment 1 than normal tissue (P < 0.05). Tumor CNR and SIR were greater on compartment-1 signal maps than conventional DWI (P < 0.05) and increased with model order.Data Conclusion: The 4-compartment signal model best described diffusion in the prostate. Compartmental signal contributions revealed by this model may improve assessment of prostate cancer. Level of Evidence 3 Technical Efficacy Stage 3 J. MAGN. RESON. IMAGING 2021;53:628-639. [ABSTRACT FROM AUTHOR]

Aim: This study investigated childhood diagnoses in children born extremely preterm before 24 weeks of gestation. Methods: Diagnoses of neurodevelopmental disorders and selected somatic diagnoses were retrospectively retrieved from national Swedish registries for children born before 24 weeks from 2007 to 2018. Their individual medical files were also examined. Results: We studied 383 children born at a median of 23.3 (range 21.9–23.9) weeks, with a median birthweight of 565 (range 340–874) grams. Three‐quarters (75%) had neurodevelopmental disorders, including speech disorders (52%), intellectual disabilities (40%), attention deficit hyperactivity disorder (30%), autism spectrum disorders (24%), visual impairment (22%), cerebral palsy (17%), epilepsy (10%) and hearing impairment (5%). More boys than girls born at 23 weeks had intellectual disabilities (45% vs. 27%, p < 0.01) and visual impairment (25% vs. 14%, p < 0.01). Just over half of the cohort (55%) received habilitation care. The majority (88%) had somatic diagnoses, including asthma (63%) and failure to thrive/short stature (39%). Conclusion: Most children born before 24 weeks had neurodevelopmental disorders and/or additional somatic diagnoses in childhood and were referred to habilitation services. Clinicians should be aware of the multiple health and developmental problems affecting these children. Resources are needed to identify their long‐term support needs at an early stage. [ABSTRACT FROM AUTHOR]

Particles released from cobalt-chromium-molybdenum (CoCrMo) alloys are considered common elicitors of chronic inflammatory adverse effects. There is a lack of data demonstrating particle numbers, size distribution and elemental composition of bone marrow resident particles which would allow for implementation of clinically relevant test strategies in bone marrow models at different degrees of exposure. The aim of this study was to investigate metal particle exposure in human periprosthetic bone marrow of three types of arthroplasty implants. Periprosthetic bone marrow sections from eight patients exposed to CoCrMo particles were analyzed via spatially resolved and synchrotron-based nanoscopic X-ray fluorescence imaging. These analyses revealed lognormal particle size distribution patterns predominantly towards the nanoscale. Analyses of particle numbers and normalization to bone marrow volume and bone marrow cell number indicated particle concentrations of up to 1 × 1011 particles/ml bone marrow or 2 × 104 particles/bone marrow cell, respectively. Analyses of elemental ratios of CoCrMo particles showed that particularly the particles' Co content depends on particle size. The obtained data point towards Co release from arthroprosthetic particles in the course of dealloying and degradation processes of larger particles within periprosthetic bone marrow. This is the first study providing data based on metal particle analyses to be used for future in vitro and in vivo studies of possible toxic effects in human bone marrow following exposure to arthroprosthetic CoCrMo particles of different concentration, size, and elemental composition. [ABSTRACT FROM AUTHOR]

Using data from seven microworld experiments (N = 841), we investigated how participants reacted to simulated disasters with different risk profiles in a microworld. Our central focus was to investigate how the scale of a disaster affected the choices and response times of these reactions. We find that one-off large-scale disasters prompted stronger reactions to move away from the affected region than recurrent small-scale adverse events, despite the overall risk of a disaster remaining constant across both types of events. A subset of participants are persistent risk-takers who repeatedly put themselves in harm’s way, despite having all the experience and information required to avoid a disaster. Furthermore, while near-misses prompted a small degree of precautionary movement to reduce one’s subsequent risk exposure, directly experiencing the costs of the disaster substantially increased the desire to move away from the affected region. Together, the results point to ways in which laboratory risk-taking tasks can be used to inform the kinds of communication and interventions that seek to mitigate people’s exposure to risk. [ABSTRACT FROM AUTHOR]

Purpose: Restriction spectrum imaging (RSI) decomposes the diffusion‐weighted MRI signal into separate components of known apparent diffusion coefficients (ADCs). The number of diffusion components and optimal ADCs for RSI are organ‐specific and determined empirically. The purpose of this work was to determine the RSI model for breast tissues. Methods: The diffusion‐weighted MRI signal was described using a linear combination of multiple exponential components. A set of ADC values was estimated to fit voxels in cancer and control ROIs. Later, the signal contributions of each diffusion component were estimated using these fixed ADC values. Relative‐fitting residuals and Bayesian information criterion were assessed. Contrast‐to‐noise ratio between cancer and fibroglandular tissue in RSI‐derived signal contribution maps was compared to DCE imaging. Results: A total of 74 women with breast cancer were scanned at 3.0 Tesla MRI. The fitting residuals of conventional ADC and Bayesian information criterion suggest that a 3‐component model improves the characterization of the diffusion signal over a biexponential model. Estimated ADCs of triexponential model were D1,3 = 0, D2,3 = 1.5 × 10−3, and D3,3 = 10.8 × 10−3 mm2/s. The RSI‐derived signal contributions of the slower diffusion components were larger in tumors than in fibroglandular tissues. Further, the contrast‐to‐noise and specificity at 80% sensitivity of DCE and a subset of RSI‐derived maps were equivalent. Conclusion: Breast diffusion‐weighted MRI signal was best described using a triexponential model. Tumor conspicuity in breast RSI model is comparable to that of DCE without the use of exogenous contrast. These data may be used as differential features between healthy and malignant breast tissues. [ABSTRACT FROM AUTHOR]

Background The outcomes of hematogenous periprosthetic joint infection (PJI) and reasons for failure are largely unknown. Methods The outcomes of consecutive patients with hematogenous PJI treated at our institution between 2010 and 2019 were evaluated. Failure was classified as persistence or relapse of infection or new infection. Failure-free survival was assessed using Kaplan-Meier analysis. Proportions between groups were compared with the Fisher exact test. Results One hundred thirty-two hematogenous PJI episodes involving knee (n = 76), hip (n = 54), shoulder (n = 1), or elbow (n = 1) prostheses experienced by 110 patients were included. The median follow-up (range) was 20.7 (0.2–89.9) months. Hematogenous PJIs were caused by Staphylococcus aureus (n = 49), Streptococcus spp. (n = 36), Enterococcus faecalis (n = 17), Enterobacterales (n = 16), coagulase-negative staphylococci (n = 9), and other (n = 6). Debridement and implant retention were performed in 50 (38%), prosthesis exchange or removal in 79 (60%), and no surgery in 3 episodes (2%). Treatment failed in 42 episodes (32%), including 6 infection-related deaths. Among 36 nonfatal failures, 21 were caused by a new pathogen and 8 by the same pathogen, in 7 episodes no pathogen was isolated. Of all nonfatal failures, 19 (53%) PJIs were of hematogenous origin. Identification of the primary focus, causative pathogen, and CRIME80 Score did not influence treatment outcome, but the failure rate was higher following prosthesis retention compared with multistage exchange. Conclusions Persistence-/relapse-free survival after treatment of hematogenous PJI was high (84%). New hematogenous PJI due to the same or a new pathogen occurred frequently, reducing treatment success to 62% after 4 years of follow-up, suggesting an individual predisposition to hematogenous PJI. The outcome was similar for different pathogens but worse in episodes treated with prosthesis retention compared with multistage exchange. [ABSTRACT FROM AUTHOR]

Diffusion-weighted magnetic resonance imaging (DWI) of the musculoskeletal system has various applications, including visualization of bone tumors. However, DWI acquired with echo-planar imaging is susceptible to distortions due to static magnetic field inhomogeneities. This study aimed to estimate spatial displacements of bone and to examine whether distortion corrected DWI images more accurately reflect underlying anatomy. Whole-body MRI data from 127 prostate cancer patients were analyzed. The reverse polarity gradient (RPG) technique was applied to DWI data to estimate voxel-level distortions and to produce a distortion corrected DWI dataset. First, an anatomic landmark analysis was conducted, in which corresponding vertebral landmarks on DWI and anatomic T2-weighted images were annotated. Changes in distance between DWI- and T2-defined landmarks (i.e., changes in error) after distortion correction were calculated. In secondary analyses, distortion estimates from RPG were used to assess spatial displacements of bone metastases. Lastly, changes in mutual information between DWI and T2-weighted images of bone metastases after distortion correction were calculated. Distortion correction reduced anatomic error of vertebral DWI up to 29 mm. Error reductions were consistent across subjects (Wilcoxon signed-rank p < 10–20). On average (± SD), participants' largest error reduction was 11.8 mm (± 3.6). Mean (95% CI) displacement of bone lesions was 6.0 mm (95% CI 5.0–7.2); maximum displacement was 17.1 mm. Corrected diffusion images were more similar to structural MRI, as evidenced by consistent increases in mutual information (Wilcoxon signed-rank p < 10–12). These findings support the use of distortion correction techniques to improve localization of bone on DWI. [ABSTRACT FROM AUTHOR]

Many programmers use dependently typed languages such as Coq to machine-verify high-assurance software. However, existing compilers for these languages provide no guarantees after compiling, nor when linking after compilation. Type-preserving compilers preserve guarantees encoded in types and then use type checking to verify compiled code and ensure safe linking with external code. Unfortunately, standard compiler passes do not preserve the dependent typing of commonly used (intensional) type theories. This is because assumptions valid in simpler type systems no longer hold, and intensional dependent type systems are highly sensitive to syntactic changes, including compilation. We develop an A-normal form (ANF) translation with join-point optimization—a standard translation for making control flow explicit in functional languages—from the Extended Calculus of Constructions (ECC) with dependent elimination of booleans and natural numbers (a representative subset of Coq). Our dependently typed target language has equality reflection, allowing the type system to encode semantic equality of terms. This is key to proving type preservation and correctness of separate compilation for this translation. This is the first ANF translation for dependent types. Unlike related translations, it supports the universe hierarchy, and does not rely on parametricity or impredicativity. [ABSTRACT FROM AUTHOR]

Epidemiological simulations as a method are used to better understand and predict the spreading of infectious diseases, for example of COVID-19. This paper presents an approach that combines a well-established approach from transportation modelling that uses person-centric data-driven human mobility modelling with a mechanistic infection model and a person-centric disease progression model. The model includes the consequences of different room sizes, air exchange rates, disease import, changed activity participation rates over time (coming from mobility data), masks, indoors vs. outdoors leisure activities, and of contact tracing. It is validated against the infection dynamics in Berlin (Germany). The model can be used to understand the contributions of different activity types to the infection dynamics over time. It predicts the effects of contact reductions, school closures/vacations, masks, or the effect of moving leisure activities from outdoors to indoors in fall, and is thus able to quantitatively predict the consequences of interventions. It is shown that these effects are best given as additive changes of the reproduction number R. The model also explains why contact reductions have decreasing marginal returns, i.e. the first 50% of contact reductions have considerably more effect than the second 50%. Our work shows that is is possible to build detailed epidemiological simulations from microscopic mobility models relatively quickly. They can be used to investigate mechanical aspects of the dynamics, such as the transmission from political decisions via human behavior to infections, consequences of different lockdown measures, or consequences of wearing masks in certain situations. The results can be used to inform political decisions. [ABSTRACT FROM AUTHOR]

Protein arginine methyltransferase 6 (PRMT6) catalyses the asymmetric dimethylation of arginines on numerous substrate proteins within the human cell. In particular, PRMT6 methylates histone H3 arginine 2 (H3R2) which affects both gene repression and activation. However, the substrate specificity of PRMT6 has not been comprehensively analysed. Here, we systematically characterise the substrate recognition motif of PRMT6, finding that it has broad specificity and recognises the RG motif. Working with a H3 tail peptide as a template, on which we made 204 amino acid substitutions, we use targeted mass spectrometry to measure their effect on PRMT6 in vitro activity. We first show that PRMT6 methylates R2 and R8 in the H3 peptide, although H3R8 is methylated with lower efficiency and is not an in vivo PRMT6 substrate. We then quantify the effect of 194 of these amino acid substitutions on methylation at both H3R2 and H3R8. In both cases, we find that PRMT6 tolerates essentially any amino acid substitution in the H3 peptide, but that positively charged and bulky residues are preferred near the target arginine. We show that PRMT6 also has preference for glycine, but only in the position immediately following the target arginine. This indicates that PRMT6 recognises the RG motif rather than the RGG motif. We further confirm this preference for the RG motif on another PRMT6 substrate, histone H4R3. This broad specificity and recognition of RG rather than RGG are distinctive among the PRMT family and has implications for the development of drugs to selectively target PRMT6. Databases: Panorama Public (https://panoramaweb.org/PRMT6motif.url); ProteomeXchange (PXD016711). [ABSTRACT FROM AUTHOR]

Background: Diffusion magnetic resonance imaging (MRI) is integral to detection of prostate cancer (PCa), but conventional apparent diffusion coefficient (ADC) cannot capture the complexity of prostate tissues and tends to yield noisy images that do not distinctly highlight cancer. A four‐compartment restriction spectrum imaging (RSI4) model was recently found to optimally characterize pelvic diffusion signals, and the model coefficient for the slowest diffusion compartment, RSI4‐C1, yielded greatest tumor conspicuity. Purpose: To evaluate the slowest diffusion compartment of a four‐compartment spectrum imaging model (RSI4‐C1) as a quantitative voxel‐level classifier of PCa. Study Type: Retrospective. Subjects: Forty‐six men who underwent an extended MRI acquisition protocol for suspected PCa. Twenty‐three men had benign prostates, and the other 23 men had PCa. Field Strength/Sequence: A 3 T, multishell diffusion‐weighted and axial T2‐weighted sequences. Assessment: High‐confidence cancer voxels were delineated by expert consensus, using imaging data and biopsy results. The entire prostate was considered benign in patients with no detectable cancer. Diffusion images were used to calculate RSI4‐C1 and conventional ADC. Classifier images were also generated. Statistical Tests: Voxel‐level discrimination of PCa from benign prostate tissue was assessed via receiver operating characteristic (ROC) curves generated by bootstrapping with patient‐level case resampling. RSI4‐C1 was compared to conventional ADC for two metrics: area under the ROC curve (AUC) and false‐positive rate for a sensitivity of 90% (FPR90). Statistical significance was assessed using bootstrap difference with two‐sided α = 0.05. Results: RSI4‐C1 outperformed conventional ADC, with greater AUC (mean 0.977 [95% CI: 0.951–0.991] vs. 0.922 [0.878–0.948]) and lower FPR90 (0.032 [0.009–0.082] vs. 0.201 [0.132–0.290]). These improvements were statistically significant (P < 0.05). Data Conclusion: RSI4‐C1 yielded a quantitative, voxel‐level classifier of PCa that was superior to conventional ADC. RSI classifier images with a low false‐positive rate might improve PCa detection and facilitate clinical applications like targeted biopsy and treatment planning. Evidence Level: 3 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

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Background: Diffusion‐weighted (DW) echo‐planar imaging (EPI) is prone to geometric distortions due to B0 inhomogeneities. Both prospective and retrospective approaches have been developed to decrease and correct such distortions. Purpose The purpose of this work was to evaluate the performance of reduced‐field‐of‐view (FOV) acquisition and retrospective distortion correction methods in decreasing distortion artifacts for breast imaging. Coverage of the axilla in reduced‐FOV DW magnetic resonance imaging (MRI) and residual distortion were also assessed. Study Type: Retrospective. Population/Phantom Breast phantom and 169 women (52.4 ± 13.4 years old) undergoing clinical breast MRI. Field Strength/Sequence: A 3.0 T/ full‐ and reduced‐FOV DW gradient‐echo EPI sequence. Assessment Performance of reversed polarity gradient (RPG) and FSL topup in correcting breast full‐ and reduced‐FOV EPI data was evaluated using the mutual information (MI) metric between EPI and anatomical images. Two independent breast radiologists determined if coverage on both EPI data sets was adequate to evaluate axillary nodes and identified residual nipple distortion artifacts. Statistical Tests: Two‐way repeated‐measures analyses of variance and post hoc tests were used to identify differences between EPI modality and distortion correction method. Generalized linear mixed effects models were used to evaluate differences in axillary coverage and residual nipple distortion. Results: In a breast phantom, residual distortions were 0.16 ± 0.07 cm and 0.22 ± 0.13 cm in reduced‐ and full‐FOV EPI with both methods, respectively. In patients, MI significantly increased after distortion correction of full‐FOV (11 ± 5% and 18 ± 9%, RPG and topup) and reduced‐FOV (8 ± 4% both) EPI data. Axillary nodes were observed in 99% and 69% of the cases in full‐ and reduced‐FOV EPI images. Residual distortion was observed in 93% and 0% of the cases in full‐ and reduced‐FOV images. Data Conclusion: Minimal distortion was achieved with RPG applied to reduced‐FOV EPI data. RPG improved distortions for full‐FOV images but with more modest improvements and limited correction near the nipple. Evidence Level 3 Technical Efficacy: Stage 1 [ABSTRACT FROM AUTHOR]