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Background: Female sex is frequently cited as a risk factor for anthracycline cardiotoxicity based on pediatric data, but the role of sex in the development of cardiotoxicity has not been clearly established in adults., Objectives: To assess the effect of female sex on the development of incident heart failure (HF) in adult patients treated with anthracyclines., Methods: This was a retrospective cohort study of 1525 adult patients with no prior history of HF or cardiomyopathy who were treated with anthracyclines between 1992 and 2019. The primary outcome was new HF within 5 years of the first dose of anthracyclines. The effect of sex was assessed using Cox proportional hazards and competing risk models., Results: Over a median (IQR) follow-up of 1.02 (0.30-3.01) years, 4.78% of patients developed HF (44 men and 29 women). Female sex was not associated with the primary outcome in a multivariable Cox proportional hazards model (HR 0.87; 95% CI 0.53-1.43; P = 0.58). Similar results were observed in a multivariable model accounting for the competing risk of death (HR 0.94; 95% CI 0.39-2.25; P = 0.88). Age, coronary artery disease and hematopoietic stem cell transplant were associated with the primary outcome in a multivariable Cox proportional hazards model. Age and body mass index were associated with the primary outcome in a multivariable competing risk model., Conclusions: In this large, single-center, retrospective cohort study, female sex was not associated with incident HF in adult patients treated with anthracyclines., Condensed Abstract: Female sex is frequently cited as a risk factor for anthracycline cardiotoxicity based on pediatric data, but the role of sex in the development of cardiotoxicity has not been clearly established in adults. In this retrospective cohort study, we assessed the effect of female sex on the development of incident heart failure in adult patients treated with anthracyclines. Using Cox proportional hazards and competing risk regression models, we found that there was no association between female sex and heart failure after treatment with anthracyclines., Competing Interests: DISCLOSURES AA has consulted for Sanofi, AstraZeneca, Cytokinetics, and OncLive and serves as the principal investigator for a sponsored research agreement with Genentech, all unrelated to the submitted work. JS reports grant funding from Edwards Lifesciences, Anumana, Ultromics, and HeartSciences, consulting for Bracco Diagnostics, and speaker fees from Northwest Imaging Forums, unrelated to the submitted work. The remaining authors have nothing to disclose., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Left bundle branch area pacing (LBBAP) has been shown to be a feasible option for patients requiring ventricular pacing., Objective: The purpose of this study was to compare clinical outcomes between LBBAP and RVP among patients undergoing pacemaker implantation METHODS: This observational registry included patients who underwent pacemaker implantations with LBBAP or RVP for bradycardia indications between April 2018 and October 2020. The primary composite outcome included all-cause mortality, heart failure hospitalization (HFH), or upgrade to biventricular pacing. Secondary outcomes included the composite endpoint among patients with a prespecified burden of ventricular pacing and individual outcomes., Results: A total of 703 patients met inclusion criteria (321 LBBAP and 382 RVP). QRS duration during LBBAP was similar to baseline (121 ± 23 ms vs 117 ± 30 ms; P = .302) and was narrower compared to RVP (121 ± 23 ms vs 156 ± 27 ms; P <.001). The primary composite outcome was significantly lower with LBBAP (10.0%) compared to RVP (23.3%) (hazard ratio [HR] 0.46; 95%T confidence interval [CI] 0.306-0.695; P <.001). Among patients with ventricular pacing burden >20%, LBBAP was associated with significant reduction in the primary outcome compared to RVP (8.4% vs 26.1%; HR 0.32; 95% CI 0.187-0.540; P <.001). LBBAP was also associated with significant reduction in mortality (7.8% vs 15%; HR 0.59; P = .03) and HFH (3.7% vs 10.5%; HR 0.38; P = .004)., Conclusion: LBBAP resulted in improved clinical outcomes compared to RVP. Higher burden of ventricular pacing (>20%) was the primary driver of these outcome differences., (Copyright © 2021 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate diagnostic accuracy and clinical outcomes of patients with porcelain gallbladder (GB) diagnosed on CT., Materials and Methods: In this IRB-approved, HIPAA-compliant study, consecutive patients with porcelain gallbladder reported on CT between December 1, 2000 and August 31, 2017 in a tertiary academic center were included. Two radiologists independently reviewed CT images and confirmed presence of porcelain gallbladder. Discrepant cases were reviewed by a third reader with 15 years of experience in abdominal imaging. Porcelain gallbladder diagnosis was confirmed by surgery/pathology or follow-up imaging., Results: Porcelain gallbladder was reported in 133 CT studies. Radiologist review and pathology results confirmed porcelain gallbladder in 90/133 (68%) patients (age 71.6 ± 13.8 years, 57% female). One third (42/133; 32%) of CT reports were false positive; 1/133 (1%) remained indeterminate. Frequent pitfalls included: stones filling the whole gallbladder lumen in 39/43 (91%), sludge in 3/43 (7%) and mucosal enhancement in 2/43 (5%). In 5/90 (6%) patients, concurrent gallbladder cancer was noted on the initial CT scan. No patient developed subsequent gallbladder cancer during 6.6 ± 4.6 years of follow-up. One third (30/90, 33%) of patients with porcelain gallbladder have deceased during the follow-up period, all from unrelated causes., Conclusion: At the time of presentation with porcelain gallbladder, 6% of patients had concurrent gallbladder cancer. No patient with porcelain gallbladder alone diagnosed on CT developed gallbladder cancer during a follow-up of 6.6 ± 4.6 years. Porcelain gallbladder is overcalled on CT, with frequent pitfalls including gallstones filling the whole gallbladder lumen, sludge, and wall enhancement., (Copyright © 2020 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Introduction: To improve retention on HIV treatment in Africa, public health programs are promoting a family of innovations to service delivery-referred to as "differentiated service delivery" (DSD) models-which seek to better meet the needs of both systems and patients by reducing unnecessary encounters, expanding access, and incorporating peers and patients in patient care. Data on the relative desirability of different models to target populations, which is currently sparse, can help guide prioritization of specific models during scale-up., Methods: We conducted a discrete choice experiment to assess patient preferences for various characteristics of treatment services. Clinically stable people living with HIV were recruited from an HIV clinic in Kisumu, Kenya. We selected seven attributes of DSD models drawn from literature review and previous qualitative work. We created a balanced and orthogonal design to identify main term effects. A total of ten choice tasks were solicited per respondent. We calculated relative utility (RU) for each attribute level, a numerical representation of the strength of patient preference. Data were analyzed using a Hierarchical Bayesian model via Sawtooth Software., Results: One hundred and four respondents (37.5% men, 41.1 years mean age) preferred receiving care at a health facility, compared with home-delivery or a community meeting point (RU = 69.3, -16.2, and -53.1, respectively; p << 0.05); receiving those services from clinicians and pharmacists-as opposed to lay health workers or peers (RU = 21.5, 5.9, -24.5; p < 0.05); and preferred an individual support system over a group support system (RU = 15.0 and 4.2; p < 0.05). Likewise, patients strongly preferred longer intervals between both clinical reviews (RU = 40.1 and -50.7 for 6- and 1-month spacing, respectively; p < 0.05) and between ART collections (RU = 33.6 and -49.5 for 6- and1-month spacing, respectively; p < 0.05)., Conclusion: Although health systems find community- and peer-based DSD models attractive, clinically stable patients expressed a preference for facility-based care as long as clinical visits were extended to biannual. These data suggest that multi-month scripting and fast-track models best align with patient preferences, an insight which can help prioritize use of different DSD models in the region., Competing Interests: The authors have declared that no competing interests exist.

Objectives: The aims of the study were to systematically analyze causes for radiation dose outliers in emergency department noncontrast head computed tomographies (CTs), to develop and implement standardized system solutions, and audit program success for an extended period of time., Methods: This study was performed in a large, tertiary academic center between January 2015 and September 2017. Four phases of radiation dose data collection with and without prior interventions were performed. Outliers from 5 categories were evaluated for appropriateness in consensus by 2 radiologists and a senior CT technologist., Results: A total of 275 ± 15 CTs per period were included. Fifty-seven inappropriate scanning parameters were found in 24 (9%) of 254 CTs during the first analysis, 27 in 21 (7%) of 290 CTs during the second, 11 in 10 (4%) of 276 during the third assessment (P = 0.006). After a year without additional intervention, the number remained stable (14 in 11/281 CTs, 4%)., Conclusions: Combining a dose reporting system, individual case analysis, staff education, and implementation of systemic solutions lead to sustained radiation exposure improvement., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: To evaluate the impact of patient positioning during CT-guided lung biopsy on patients' outcomes., Methods: In this retrospective, IRB-approved, HIPAA-compliant study, consecutive CT-guided lung biopsies performed on 5/1/2015-12/26/2017 were included. Correlation between incidence of pneumothorax, chest tube placement, pulmonary bleeding with patient, and procedure characteristics was evaluated. Lesion-trachea-table angle (LTTA) was defined as an angle between the lesion, trachea, and horizontal line parallel to the table. Lesion above trachea has a positive LTTA. Univariate and multivariate logistic regression analysis was performed., Results: A total of 423 biopsies in 409 patients (68 ± 11 years, 231/409, 56% female) were included in the study. Pneumothorax occurred in 83/423 (20%) biopsies with chest tube placed in 11/423 (3%) biopsies. Perilesional bleeding occurred in 194/423 (46%) biopsies and hemoptysis in 20/423 (5%) biopsies. Univariate analysis showed an association of pneumothorax with smaller lesions (p = 0.05), positive LTTA (p = 0.002), and lesions not attached to pleura (p = 0.026) with multivariate analysis showing lesion size and LTTA to be independent risk factors. Univariate analysis showed an association of increased pulmonary bleeding with smaller lesions (p < 0.001), no attachment to the pleura (p < 0.001), needle throw < 16 mm (p = 0.05), and a longer needle path (p < 0.001). Multivariate analysis showed lesion size, a longer needle path, and lesions not attached to the pleura to be independently associated with perilesional bleeding. Risk factors for hemoptysis were longer needle path (p = 0.002), no attachment to the pleura (p = 0.03), and female sex (p = 0.04)., Conclusions: Interventional radiologists can reduce the pneumothorax risk during the CT-guided biopsy by positioning the biopsy site below the trachea., Key Points: • Positioning patient with lesion to be below the trachea for the CT-guided lung biopsy results in lower rate of pneumothorax, as compared with the lesion above the trachea. • Positioning patient with lesion to be below the trachea for the CT-guided lung biopsy does not affect rate of procedure-associated pulmonary hemorrhage or hemoptysis.

Objective: To assess impact of single-energy metal artifact reduction (SEMAR) algorithm utilizing retrospective adaptive thresholding in reducing metal artifacts in the abdomen and pelvis., Methods: In this prospective institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study, 90 patients with various metals (n = 97) on computed tomography of abdomen and pelvis (Canon Medical, Aquilion ONE and PRIME) scanned 07/2017-09/2018 with SEMAR retrospectively applied were included. Density was measured in the near and far field to the metals. Density standard deviation (SD), representing artifact severity, was compared with and without SEMAR applied. Two trained human observers independently evaluated severity of artifacts on a five-point scale (0, no artifact; 5, severe artifact)., Results: The SEMAR significantly decreased artifact severity in the near field of high-density metal implants (SD of 204 ± 101HU without vs. 66 ± 40HU with SEMAR, P < 0.001). In the far field, the artifact severity was similar (40 ± 31HU without vs. 36 ± 27HU with SEMAR, P = 0.41). Artifact severity was decreased adjacent to low-density metal in the near field (SD of 86 ± 56HU without vs 49 ± 30HU with SEMAR, P < 0.001). In the far field to the low-density metals artifact severity was similar (33 ± 29HU without vs. 31 ± 27HU with SEMAR, P = 0.79). Subjectively, artifacts severity decreased for high-density metals in near field by 1.3 ± 1.0, and in far field by 0.7 ± 0.7 and for low-density metals in the near field by 0.7 ± 1.0, far field 0.4 ± 0.5, all P < 0.05., Conclusions: The SEMAR retrospective algorithm with adaptive thresholding subjectively and objectively reduced near-field artifacts generated by high- and low-density metals.

Background: The fluoropyrimidines, 5-fluorouracil (5-FU) and capecitabine, are commonly used chemotherapeutic agents that have been associated with coronary vasospasm., Methods: In this retrospective case-control study, we identified patients at our institution who received 5-FU or capecitabine in 2018. We compared characteristics of patients who experienced cardiotoxicity with controls. We described phenotypes and outcomes of cardiotoxic cases., Results: We identified 177 patients who received fluoropyrimidines. After adjudication, 4.5% of the cohort met the criteria for cardiovascular toxicity. Coronary artery disease was more common among cases than controls (38% vs. 7%, p < .05). There was also a trend toward increased prevalence of cardiovascular risk factors in cases compared with controls. Most cardiotoxic cases had chest pain, although a minority of cases presented with nonischemic cardiomyopathy., Conclusion: Cardiotoxicity phenotypes associated with fluoropyrimidine use are not limited to coronary vasospasm. Cardiac risk factors and ischemic heart disease were highly prevalent among patients with cardiotoxicity., (© AlphaMed Press 2019.)

Objectives: Fraud in the aged is an emerging public health problem. An increasingly common form of deception is conducted online. However, identification of cognitive and socioemotional risk factors has not been undertaken yet. In this endeavor, this study extended previous work suggesting age effects on susceptibility to online deception., Methods: Susceptibility was operationalized as clicking on the link in simulated spear-phishing emails that young (18-37 years), young-old (62-74 years), and middle-old (75-89 years) Internet users received, without knowing that the emails were part of the study. Participants also indicated for a set of spear-phishing emails how likely they would click on the embedded link (susceptibility awareness) and completed cognitive and socioemotional measures to determine susceptibility risk profiles., Results: Higher susceptibility was associated with lower short-term episodic memory in middle-old users and with lower positive affect in young-old and middle-old users. Greater susceptibility awareness was associated with better verbal fluency in middle-old users and with greater positive affect in young and middle-old users., Discussion: Short-term memory, verbal fluency, and positive affect in middle-old age may contribute to resilience against online spear-phishing attacks. These results inform mechanisms of online fraud susceptibility and real-life decision-supportive interventions toward fraud risk reduction in aging., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: The objective of this study was to assess the impact of preprocedural time-out on workflow and patient safety in computed tomography (CT)-guided procedures., Methods: In this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study, preprocedure time-out was assessed by an independent observer in CT-guided procedures performed from January 16, 2018, to May 15, 2018. Anonymous survey of 302 radiology team members involved in image-guided procedures about preprocedure time-out was performed using REDCap., Results: Preprocedure time-out for 100 CT-guided procedures (biopsies, drainages, ablations) was observed. Procedures were recruited per observer availability and thus were nonconsecutive and nonrandom. Preprocedure time-out was performed in 100 procedures (100%). Median duration was 60 seconds (interquartile range, 60-71 seconds). Scripted checklist was followed in 52 cases (52/100, 52%). Omissions from the preprocedure time-out were identified in 40 cases (40/100, 40%) and were much more frequent when scripted checklist was not used (30/48 [63%] vs 10/52 [19%], P < 0.005). One case (1/100, 1%) was postponed due to abnormal coagulation parameters discovered during the time-out. Three cases (3/100, 3%) were delayed by 3 minutes to address other safety issues. In additional 14 cases (14/100, 14%), safety issues were raised during the time-out, which were resolved in less than 30 seconds.A total of 137 (45%) of 302 survey responses from 54 radiologists (39%), 55 technologists (40%), and 28 nurses (20%) were received. Forty-eight respondents (48/137, 35%) encountered a procedure that was cancelled or delayed as a result of information identified during time-out. Ninety-six percent (131/137) of respondents stated that time-out improves teamwork, 98% (134/137) stated that it enhances communication between the team members, and 93% (127/137) stated that it identifies and resolves problems and ambiguities., Conclusions: Scripted preprocedure time-out for CT-guided procedures takes approximately 1 minute to execute and detects safety issues in 18% of cases.

Phishing is fundamental to cyber attacks. This research determined the effect of Internet user age and email content such as weapons of influence (persuasive techniques that attackers can use to lure individuals to fall for an attack) and life domains (a specific topic or aspect of an individual's life that attackers can focus an emails on) on spear-phishing (targeted phishing) susceptibility. One-hundred young and 58 older users received, without their knowledge, daily simulated phishing emails over 21 days. A browser plugin recorded their clicking on links in the emails as an indicator of their susceptibility. Forty-three percent of users fell for the simulated phishing emails, with older women showing the highest susceptibility. While susceptibility in young users declined across the study, susceptibility in older users remained stable. The relative effectiveness of the attacks differed by weapons of influence and life domains with age-group variability. In addition, older compared to young users reported lower susceptibility awareness. These findings support effects of Internet user demographics and email content on susceptibility to phishing and emphasize the need for personalization of the next generation of security solutions.

Spam has been increasingly used for malware distribution. This paper analyzed modern spam from an age-comparative perspective to (i) discover the extent to which psychological weapons of influence and life domains were represented in today's spam emails and (ii) clarify variations in the use of these weapons and life domains by user demographics. Thirty five young and 32 older participants forwarded 18,605 emails from their spam folder to our study email account. A random set of 961 emails were submitted to qualitative content coding and quantitative statistical analysis. Reciprocation was the most prevalent weapon; financial, leisure, and independence the most prevalent life domains. Older adults received health and independence-related spam emails more frequently, while young adults received leisure and occupation-related spam emails more often. These age differences show a level of targeting by user demographics in current spam campaigns. This targeting shows the need for age-tailored demographic warnings highlighting the presence of influence and pretexting (life domains) for suspicious emails for improved response to cyber-attacks that could result from spam distribution. The insights from this study and the produced labeled dataset of spam messages can inform the development of the next generation of such solutions, especially those based on machine learning., Competing Interests: Competing interests The authors declare that they have no competing interests.

Cell migration is regulated by several mechanotransduction pathways, which consist of sensing and converting mechanical microenvironmental cues to internal biochemical cellular signals, such as protein phosphorylation and lipid signaling. While there has been significant progress in understanding protein changes in the context of mechanotransduction, lipid signaling is more difficult to investigate. In this study, physical cues of stiffness (10, 100, 400 kPa, and glass), and microrod or micropost topography were manipulated in order to reprogram primary fibroblasts and assess the effects of lipid signaling on the actin cytoskeleton. In an in vitro wound closure assay, primary cardiac fibroblast migration velocity was significantly higher on soft polymeric substrata. Modulation of PIP2 availability through neomycin treatment nearly doubled migration velocity on 10 kPa substrata, with significant increases on all stiffnesses. The distance between focal adhesions and the lamellar membrane (using wortmannin treatment to increase PIP2 via PI3K inhibition) was significantly shortest compared to untreated fibroblasts grown on the same surface. PIP2 localized to the leading edge of migrating fibroblasts more prominently in neomycin-treated cells. The membrane-bound protein, lamellipodin, did not vary under any condition. Additionally, fifteen micron-high micropost topography, which blocks migration, concentrates PIP2 near to the post. Actin dynamics within stress fibers, measured by fluorescence recovery after photobleaching, was not significantly different with stiffness, microtopography, nor with drug treatment. PIP2-modulating drugs delivered from microrod structures also affected migration velocity. Thus, manipulation of the microenvironment and lipid signaling regulatory drugs might be beneficial in improving therapeutics geared toward wound healing., (© 2017 Wiley Periodicals, Inc.)

Background: Dizziness is a common and very distressing presentation in general practice. In more than half of these cases, the dizziness is due to vertigo, which is the illusion of movement of the body or its surroundings. It can have central or peripheral causes, and determining the cause can be difficult., Objective: The aim of this article is to provide a clear framework for approaching patients who present with vertigo. A suggested approach to the assessment of vertigo is outlined., Discussion: The causes of vertigo may be central (involving the brainstem or cerebellum) or peripheral (involving the inner ear). A careful history and physical examination can distinguish between these causes. The most common causes of vertigo seen in primary care are benign paroxysmal positional vertigo (BPPV), vestibular neuronitis (VN) and Ménière's disease. These peripheral causes of vertigo are benign, and treatment involves reassurance and management of symptoms.

Dihydrodipicolinate reductase (DHDPR; EC 1.3.1.26) catalyzes the nucleotide (NADH/NADPH) dependent second step of the lysine-biosynthesis pathway in bacteria and plants. Here, the cloning, expression, purification, crystallization and preliminary X-ray diffraction analysis of DHDPR from methicillin-resistant Staphylococcus aureus (MRSA-DHDPR) are presented. The enzyme was crystallized in a number of forms, predominantly with ammonium sulfate as a precipitant, with the best crystal form diffracting to beyond 3.65 A resolution. Crystal structures of the apo form as well as of cofactor (NADPH) bound and inhibitor (2,6-pyridinedicarboxylate) bound forms of MRSA-DHDPR will provide insight into the structure and function of this essential enzyme and valid drug target.