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Despite its vital diagnostic utility, the ionizing radiation used in CT is not benign. Patients have an increased risk of dying from a radiation-induced cancer for every pass through a CT scanner. One way to reduce this risk is to tailor CT, especially follow-up scans, to specific areas of concern. By doing so, we can help to minimize the small but real risk from this essential technology. [ABSTRACT FROM AUTHOR]

Background and Purpose: Deep learning image reconstruction allows faster MR imaging acquisitions while matching or exceeding the standard of care and can create synthetic images from existing data sets. This multicenter, multireader spine study evaluated the performance of synthetically created STIR compared with acquired STIR., Materials and Methods: From a multicenter, multiscanner data base of 328 clinical cases, a nonreader neuroradiologist randomly selected 110 spine MR imaging studies in 93 patients (sagittal T1, T2, and STIR) and classified them into 5 categories of disease and healthy. A DICOM-based deep learning application generated a synthetically created STIR series from the sagittal T1 and T2 images. Five radiologists (3 neuroradiologists, 1 musculoskeletal radiologist, and 1 general radiologist) rated the STIR quality and classified disease pathology (study 1, n = 80). They then assessed the presence or absence of findings typically evaluated with STIR in patients with trauma (study 2, n = 30). The readers evaluated studies with either acquired STIR or synthetically created STIR in a blinded and randomized fashion with a 1-month washout period. The interchangeability of acquired STIR and synthetically created STIR was assessed using a noninferiority threshold of 10%., Results: For classification, there was a decrease in interreader agreement expected by randomly introducing synthetically created STIR of 3.23%. For trauma, there was an overall increase in interreader agreement by +1.9%. The lower bound of confidence for both exceeded the noninferiority threshold, indicating interchangeability of synthetically created STIR with acquired STIR. Both the Wilcoxon signed-rank and t tests showed higher image-quality scores for synthetically created STIR over acquired STIR ( P  < .0001)., Conclusions: Synthetically created STIR spine MR images were diagnostically interchangeable with acquired STIR, while providing significantly higher image quality, suggesting routine clinical practice potential., (© 2023 by American Journal of Neuroradiology.)

Background: Research has shown children disproportionately gain excess weight over the summer months (vs. school months), with stronger effects for children with obesity. However, the question has not been investigated among children receiving care in paediatric weight management (PWM) programs., Objective: To test for seasonal variability in weight change among youth with obesity in PWM care enrolled in the Pediatric Obesity Weight Evaluation Registry (POWER)., Method: Longitudinal evaluation of a prospective cohort from 2014 to 2019 among youth in 31 PWM programs. Change in percentage of the 95th percentile for BMI (%BMIp95) was compared by quarter., Results: Participants (N = 6816) were primarily ages 6-11 (48%), female (54%), 40% non-Hispanic White, 26% Hispanic and 17% Black, and 73% had severe obesity. Children were enrolled on average 424.9 ± 401.5 days. Participants reduced their %BMIp95 every season, but compared with Quarter 3 (July-September), reductions were significantly greater in Q1 (Jan-March, b = -0.27, 95%CI -0.46, -0.09), Q2 (April-June, b = -0.21, CI -0.40, -0.03), and Q4 (October-December, b = -0.44, CI -0.63, -0.26)., Conclusion and Relevance: Across 31 clinics nationwide, children reduced their %BMIp95 every season, but reductions were significantly smaller during the summer quarter. While PWM successfully mitigated excess weight gain during every period, summer remains a high-priority time., (© 2023 World Obesity Federation.)

Background: Adherence to dietary interventions is a significant barrier in the treatment of childhood obesity. Time-limited eating (TLE) is a simple dietary approach that limits food intake to a given number of consecutive hours per day, but parental and youth acceptability of TLE in youth with obesity is unknown. This study explored the feasibility of utilizing TLE among parents and youth attending pediatric weight management (PWM)., Methods: Members of COMPASS (Childhood Obesity Multi-Program Analysis and Study System) developed a survey to assess the acceptability of TLE in families attending PWM, which included patient characteristics, current diet and sleep schedules, and interests in trying TLE. The survey was administered electronically via REDCap or manually to parents of patients between the ages of 8-17 years old and to patients 11-17 years old attending one of five PWM practices in the COMPASS network., Results: Patients (n=213) were 13.0 ± 2.5 years old, 58% female, 52% White, 22% Black, 17% Hispanic/Latino, and 47% reported a diagnosed psychological disorder. On average, parents reported their child's daily eating spanned 12.5 ± 1.9 hours (7:35am - 8:05pm) and included 5.6 ± 1.6 eating bouts (meals + snacks). Most parents reported being likely to try TLE ≤12 hours/d (TLE12: 66%), which was similar to the likelihood of following a nutrient-balanced diet (59%). Likelihood was lower for TLE ≤10 hours/d (TLE10: 39%) or ≤8 hours/d (TLE8: 26%) (p<0.001 for both). Interest in TLE was not consistently related to patient age, sex, or ethnicity, but was lower in patients with a psychiatric diagnosis vs. no diagnosis (TLE8: 19% vs. 32%; p=0.034). Patients of parents who reported being likely to try TLE, compared to those unlikely to try TLE, had shorter eating windows (p<0.001) and ate fewer snacks (p=0.006)., Conclusions: Two-thirds of parents with children attending PWM programs report interest in TLE ≤12 hours/d regardless of demographic characteristics, but interest wanes when limiting eating to ≤10 or ≤8 hours per day. Time-limited eating appears to be a feasible option in PWM settings provided treatment options are individualized based on the interests and barriers of patients and their families., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Tucker, Siegel, Murray, Han, Boyer, Reed, Allenby and Novick.)

INTRODUCTION The HealthPathways programme is an online health information system used mainly in primary health care to promote a consistent and integrated approach to patient care. AIM The aim of this study is to perform a scoping review of the methodologies used in published impact and outcomes evaluations of HealthPathways programmes. METHODS The review included qualitative, quantitative or mixed-methods evaluations of the impact or outcome of HealthPathways. MEDLINE, Embase, CINAHL and Web of Science databases were searched. Seven programme aims were identified in the impact and outcome evaluation: (1) increased awareness and use of HealthPathways; (2) general practitioners are supported to adopt best practice, patient-centred care; (3) increased appropriate use of resources and services; (4) improved quality of referrals; (5) enhanced consistent care and management of health conditions; (6) improved patient journeys through the local health system; and (7) reduction in health-care cost and increased value for money. RESULTS Twenty-one studies were included in the final review; 15 were research papers and six were reports. 'Increased awareness and use of HealthPathways' was the most frequent programme aim evaluated (n = 12). Quantitative and qualitative research methodologies, as well as prospective and retrospective data collections, have been adopted to evaluate the impact and outcome of HealthPathways. DISCUSSION Assessing the impacts and outcomes of HealthPathways may be challenging due to limitations in primary data and the interconnectedness of change across the measured aims. Each aim may therefore require specific methodologies sensitive enough to capture the impact that HealthPathways are making over time.

Background: Audiologists may choose to evaluate auditory temporal processing in assessing auditory processing abilities. Some may decide to use measures of nonverbal stimuli such as tonal or noise gap detection. Others may decide to use verbal measures such as time compressed sentences (TCS). Many may choose to use both., Purpose: Since people typically come to audiologists for auditory processing testing complaining of problems processing verbal stimuli, the question arises whether measures of nonverbal stimuli provide evidence regarding a person's abilities to processing verbal stimuli. That is, are there significant correlations between measures of verbal stimuli and nonverbal stimuli that are used to evaluate auditory temporal processing?, Research Design: The present investigation is an exploratory study using file review of 104 people seen for routine auditory processing evaluations by the authors., Study Sample: A file review was completed based on data from 104 people seen for auditory processing evaluations., Data Collection and Analyses: The data from these 104 files were used to evaluate whether there are any correlations between verbal and nonverbal measures of auditory temporal processing. The verbal measure used was the TCS subtest of the SCAN-3 while the nonverbal measures included the gap detection screening from the SCAN-3 as well as the gaps-in-noise measures. Results from these tests were compared to determine whether any significant correlations were found based on results from Pearson product moment correlational analyses., Results: None of the nonverbal measures were found to have a significant correlation with the TCS test findings based on the Pearson correlations used to analyze the data., Conclusion: Results indicate that there are no significant correlations (relationships) between measures of auditory temporal processing using nonverbal stimuli versus verbal stimuli based on the tests used in the present investigation. These findings lead to a conclusion that tests using nonverbal stimuli are measuring different auditory processes than the measure of verbal stimuli used in the present investigation. Since people typically come complaining about understanding verbal input, it is concluded that audiologists should use some verbal measure of auditory temporal processing in their auditory processing test battery., Competing Interests: None declared., (American Academy of Audiology. This article is published by Thieme.)

Eliciting a weight history can provide clinically important information to aid in treatment decision-making. This view is consistent with the life course perspective of obesity and the aim of patient-centered care, one of six domains of health care quality. However, thus far, the value and practicality of including a weight history in the clinical assessment and treatment of patients with obesity have not been systematically explored. For these reasons, the Clinical Committee of The Obesity Society established a task force to review and assess the available evidence to address five key questions. It is concluded that weight history is an essential component of the medical history for patients presenting with overweight or obesity, and there are strong and emerging data that demonstrate the importance of life stage, duration of exposure to obesity, maximum BMI, and group-based trajectory modeling in predicting risk for increased morbidity and mortality. Consideration of these and other patient-specific factors may improve risk stratification and clinical decision-making for screening, counseling, and management. Recommendations are provided for the key elements that should be included in a weight history, and several needs for future clinical research are outlined., (© 2019 The Obesity Society.)

Purpose: Our study sought to further delineate the prevalence of hypovitaminosis D and its relationship to comorbidities of childhood obesity., Methods: We conducted a retrospective chart review from 155 obese children aged 5 to 19 years who attended the Penn State Children’s Hospital Pediatric Multidisciplinary Weight Loss Program from November 2009 through November 2010. We determined the incidence of hypovitaminosis D and examined its association with comorbidities including elevated blood pressure, diabetes, acanthosis nigricans, depression, hyperlipidemia, hyperinsulinemia, and abnormal liver function test results, as well as age, sex, and geographic location., Results: Under the latest Institute of Medicine definitions, vitamin D deficiency (< 20 ng/mL) and insufficiency (20-29 ng/mL) was present in 40% and 38% of children, respectively. The prevalence of vitamin D deficiency was 27.8% in children aged 5 to 9 years, 35.4% in children aged 10 to 14 years, and 50.9% of children aged 15 years or older. Older age, African-American race, winter/spring season, higher insulin level, total number of comorbidities, and polycystic ovary syndrome (in girls) were significantly associated with vitamin D deficiency. African-American race, winter/spring season, hyperinsulinemia, elevated systolic blood pressure, urban location, and total numbers of comorbidities were significantly associated with hypovitaminosis D (< 30 ng/mL)., Conclusions: Hypovitaminosis D is associated with several medical comorbidities in obese children. Given the large percentage of children, even in our youngest age group, who are vitamin D deficient, obese children should be considered for routine vitamin D screening.

Obesity is a disease of oxidative stress (OS). Acute hyperoxia (breathing 100 % O(2)) can evoke coronary vasoconstriction by the oxidative quenching of nitric oxide (NO). To examine if weight loss would alter the hyperoxia-related coronary constriction seen in obese adolescents, we measured the coronary blood flow velocity (CBV) response to hyperoxia using transthoracic Doppler echocardiography before and after a 4-week diet and exercise regimen in 6 obese male adolescents (age 13-17 years, BMI 36.5 ± 2.3 kg/m(2)). Six controls of similar age and BMI were also studied. The intervention group lost 9 ± 1 % body weight, which was associated with a reduced resting heart rate (HR), reduced diastolic blood pressure (BP), and reduced RPP (all P < 0.05). Before weight loss, hyperoxia reduced CBV by 33 ± 3 %. After weight loss, CBV only fell by 15 ± 3 % (P < 0.05). In the control group, CBV responses to hyperoxia were unchanged during the two trials. Thus weight loss: (1) reduces HR, BP, and RPP; and (2) attenuates the OS-related coronary constrictor response seen in obese adolescents. We postulate that: (1) the high RPP before weight loss led to higher myocardial O(2) consumption, higher coronary flow and greater NO production, and in turn a large constrictor response to hyperoxia; and (2) weight loss decreased myocardial oxygen demand and NO levels. Under these circumstances, hyperoxia-induced vasoconstriction was attenuated.

The test characteristics of rapid tests for respiratory syncytial virus (RSV) in infants may differ from older children secondary to a lower likelihood of previous illness with RSV. Our main goal was to establish the test characteristics of the RSV Abbott Testpack (TP) enzyme-linked immunoabsorbent assay (EIA) in febrile infants < or = 60 days of age. Our secondary goal was to determine the likelihood of RSV given a particular clinical syndrome and a negative or positive EIA. A prospective sample of infants with a temperature > or = 38.0 degrees C was evaluated during 2 successive RSV seasons. Conventional tissue and shell vial viral cultures were utilized as the reference standard. The RSV Abbott Testpack EIA had a sensitivity of 75% (95% CI 60-90%), a specificity of 98% (95% CI 96-100%), a positive predictive value of 89% (95% CI 77-100%), a negative predictive value of 95% (95% CI 91-98%), a likelihood ratio for a positive test of 35.5 (95% CI 11.4-110.7), and a likelihood ratio for a negative test of 0.26 (95% CI 0.14-0.47). Even with a negative EIA, patients with lower and upper respiratory tract illness still had a 22.3% and 5.5% chance of harboring RSV, respectively. The RSV Abbott Testpack is a useful diagnostic tool in the detection of RSV in febrile infants but has limitations. During months typically associated with RSV disease, a positive RSV TP indicates a high likelihood of illness, but clinicians should be wary of false negatives.

In studies to date, the effectiveness of the directional microphone has been investigated independently of the signal processing scheme used in the hearing aid. In addition, the number and placement of the background noise speakers can create an advantage for a particular polar pattern (i.e., cardioid, supercardioid, and hypercardioid) in any laboratory design. With these considerations in mind, the purpose of this investigation was twofold: (1) to determine the effect of different amplitude-compression release times on speech perception ability in noise, measured with directional microphone hearing aids, and (2) to determine the impact of environment (classroom vs anechoic chamber) on those measures. Ten subjects with mild to moderate sensorineural hearing loss participated. Using an eight-speaker complex sound field, speech perception was assessed in an anechoic chamber and a typical classroom environment. None of the release times resulted in superior performance in either the anechoic or classroom environment.

Skin cancer affects 515,000 Americans every year, causing more than 7,000 deaths. Prior studies attempted, with scant success, to increase general knowledge about protection of the skin and to encourage use of sunscreens. The failure was attributed to the allure of the suntan as a symbol of health and affluence and to the "optimistic bias" (belief in one's own invulnerability) displayed by sunbathers. The study detailed here sought to increase the use by subjects of sunscreen by showing computer-altered images of their own faces, aged and disfigured by lesions. That stimulus was designed to counter false impressions and illusions of sunbathers about the benefits of the sun by demonstrating, immediately and personally, negative effects of sun exposure. Data were collected from thirty adolescents in the form of six weekly logs of sunscreen use and time spent outdoors between 10 AM and 3 PM. Results showed that the computer-altered images motivated increased use of sunscreen in the short term: subjects in the experimental groups used sunscreen almost three times as frequently as those in the control group during the experimental period (P = 0.000). Images of aging and disfiguring by lesions produced a more intense and prolonged modification in behavior than images of aging only.

A number of endogenous mouse mammary tumor virus (MMTV) proviruses encode superantigens that have the property of stimulating mature T lymphocytes in a TCR V beta-specific fashion and of mediating V beta-specific clonal deletion in developing T cells. The tumorigenic milk-borne MMTV carried by C3H and GR mice also have superantigen properties in vivo, and it has been proposed that this superantigenic function is critical to the infectivity and/or tumorigenicity of the virus. To test the requirement for superantigen properties in tumorigenic MMTV, a highly tumorigenic strain of MMTV isolated from BALB/c mice (BALB/cV virus) was analyzed for its effect on TCR V beta expression. It was found that exposure of newborn mice to milk-borne virus results in marked deletion of V beta 2-expressing CD4+ peripheral T cells. This deletion is detected in mature TCRhigh thymocytes as well as in peripheral T cells from virus-exposed mice. Deletion is dependent on expression of a permissive MHC type in mice exposed to virus. Subcutaneous injection of adult mice with virus-containing milk induces a substantial increase in V beta 2+ CD4+ cells in draining lymph nodes within 4 days. Thus, tumorigenic BALB/cV is associated with V beta 2-specific superantigen activity capable of mediating both T cell expansion and clonal deletion in vivo. These findings are consistent with a critical role of superantigen-mediated T cell activation in MMTV infection and tumorigenesis.