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The impact of stroke on the lives of individuals and the health-care system is considerable. Damage from stroke can be limited if the treatment is administered at the appropriate time, so early recognition is essential. Some common interventions (e.g., FAST) designed to help potential stroke victims discriminate stroke symptoms often result in false negatives. Strokes can present with a wide variety of symptoms, making it difficult to discriminate stroke symptoms from non-stroke symptoms. Because the probability that a given set of symptoms are stroke symptoms is typically unknown to the victim, the problem is a decision under conditions of uncertainty. Signal detection methodology allows us to consider the ability of an individual or group to discriminate between stroke symptoms and non-stroke symptoms, as well as measure the motivation or bias toward a particular decision. We examined the effects of levels of feedback on performance of a random sample of participants from Amazon Mechanical Turk. We found that feedback designed to generate liberal bias toward stroke detection yielded fewer misses than FAST while maintaining a false alarm rate below 50%. Given that strokes are difficult to discriminate, this suggests that interventions should be focused on incentivizing help-seeking behaviors in conditions of uncertainty for those most at risk.

Xanthogranulomatous epithelial tumor (XGET) and keratin-positive giant cell-rich soft tissue tumor with HMGA2-NCOR2fusion (KPGCT) are two recently described neoplasms with both distinct and overlapping clinical and histopathologic features. We hypothesized that XGET and KPGCT may be related and represent a histologic spectrum of a single entity. To test this, we sought to characterize the clinical, radiographic, immunohistochemical, ultrastructural and molecular features of additional tumors with features of XGET and/or KPGCT, which we refer to descriptively as keratin-positive xanthogranulomatous/giant cell-rich tumors (KPXG/GCT). The archives were searched for potential cases of KPXG/GCT. Clinical and imaging features were noted. Slides were assessed for histologic and immunohistochemical findings. Ultrastructural and next generation RNA sequencing-based analysis were also performed. Nine cases were identified arising in seven women and two men [median age of 33 years (range: 12–87)]. Median tumor size was 4 cm (range: 2.4–14.0 cm) and tumors presented in the thigh (2), buttock (1), forearm (2), groin (1), cranial fossa (1), ilium (1), and tibia (1). Morphologically, tumors were most frequently characterized by a fibrous capsule, with associated lymphoid reaction, enclosing a polymorphous proliferation of histiocytes, giant cells (Touton and osteoclast-types), mixed inflammatory infiltrate, hemorrhage and hemosiderin deposition, which imparted a variably xanthogranulomatous to giant cell tumor-like appearance. One case clearly showed mononuclear cells with eosinophilic cytoplasm characteristic of XGET. All cases expressed keratin and 7 of 9 were found to harbor HMGA2-NCOR2fusions including cases with xanthogranulomatous appearance. One patient developed local recurrence and multifocal pulmonary lesions, which were radiographically suspicious for metastases. Shared clinical, histologic and immunohistochemical features, and the shared presence of HMGA2-NCOR2fusions supports interpretation of KPXG/GCT as a single entity which includes XGET and KPGCT. Given limited clinical follow-up to date and rare cases with apparently aggressive findings, we provisionally regard these tumors as having uncertain biologic potential.

Surgery to treat a torn meniscus is a common orthopedic procedure, and radiologists are frequently asked to image patients with new or recurrent knee pain after meniscus surgery. However, surgery alters the MR imaging appearance of the meniscus, making the diagnosis of recurrent tear a diagnostic challenge. This article reviews relevant anatomy of the meniscus, surgical techniques used to treat meniscus tear, the roles of conventional MR imaging and MR arthrography to assess the postoperative meniscus, and the key MR imaging findings to distinguish the intact postoperative meniscus from recurrent tear.

Acral fibrochondromyxoid tumor (AFCMT) is a recently described likely benign mesenchymal neoplasm arising in the distal extremities with distinctive histologic features and a recurrent THBS1::ADGRF5fusion. We studied an additional 37 cases of AFCMT and expanded on the so-far reported clinicopathologic and molecular findings. Tumors occurred in 21 females and 16 males, ranging in age from 17 to 78 years (median age: 47), and solely involved the hands (24/37, 65%) or feet (13/37, 35%). Histologic examination revealed well-delineated uni- or multinodular tumors with prominent vasculature-rich septa and bland, chondrocyte-like tumor cells set within abundant chondromyxoid stroma. Immunohistochemical studies showed that tumor cells were positive for CD34 (25/27; 93%) and ERG (27/27; 100%), whereas negative for S100 protein (0/31). Molecular analysis revealed evidence of a THBS1::ADGRF5fusion in 17 of 19 (89%) successfully tested tumors. Clinical follow-up was available in 8 cases (median: 97 months), with multiple local recurrences in 1 case at 276, 312, and 360 months. We conclude that AFCMT is a distinct entity with reproducible morphologic, immunohistochemical, and molecular genetic features that should be differentiated from other similar appearing acral mesenchymal neoplasms.

Xanthogranulomatous epithelial tumor (XGET) and keratin-positive giant cell-rich soft tissue tumor with HMGA2-NCOR2fusion (KPGCT) are two recently described neoplasms with both distinct and overlapping clinical and histopathologic features. We hypothesized that XGET and KPGCT may be related and represent a histologic spectrum of a single entity. To test this, we sought to characterize the clinical, radiographic, immunohistochemical, ultrastructural and molecular features of additional tumors with features of XGET and/or KPGCT, which we refer to descriptively as keratin-positive xanthogranulomatous/giant cell-rich tumors (KPXG/GCT). The archives were searched for potential cases of KPXG/GCT. Clinical and imaging features were noted. Slides were assessed for histologic and immunohistochemical findings. Ultrastructural and next generation RNA sequencing-based analysis were also performed. Nine cases were identified arising in seven women and two men [median age of 33 years (range: 12–87)]. Median tumor size was 4 cm (range: 2.4–14.0 cm) and tumors presented in the thigh (2), buttock (1), forearm (2), groin (1), cranial fossa (1), ilium (1), and tibia (1). Morphologically, tumors were most frequently characterized by a fibrous capsule, with associated lymphoid reaction, enclosing a polymorphous proliferation of histiocytes, giant cells (Touton and osteoclast-types), mixed inflammatory infiltrate, hemorrhage and hemosiderin deposition, which imparted a variably xanthogranulomatous to giant cell tumor-like appearance. One case clearly showed mononuclear cells with eosinophilic cytoplasm characteristic of XGET. All cases expressed keratin and 7 of 9 were found to harbor HMGA2-NCOR2fusions including cases with xanthogranulomatous appearance. One patient developed local recurrence and multifocal pulmonary lesions, which were radiographically suspicious for metastases. Shared clinical, histologic and immunohistochemical features, and the shared presence of HMGA2-NCOR2fusions supports interpretation of KPXG/GCT as a single entity which includes XGET and KPGCT. Given limited clinical follow-up to date and rare cases with apparently aggressive findings, we provisionally regard these tumors as having uncertain biologic potential.

The Questions About Behavioral Function (QABF) has a high degree of convergent validity, but there is still a lack of agreement between the results of the assessment and the results of experimental function analysis. Machine learning (ML) may improve the validity of assessments by using data to build a mathematical model for more accurate predictions. We used published QABF and subsequent functional analyses to train ML models to identify the function of behavior. With ML models, predictions can be made from indirect assessment results based on learning from results of past experimental functional analyses. In Experiment 1, we compared the results of five algorithms to the QABF criteria using a leave-one-out cross-validation approach. All five outperformed the QABF assessment on multilabel accuracy (i.e., percentage of predictions with the presence or absence of each function indicated correctly), but false negatives remained an issue. In Experiment 2, we augmented the data with 1,000 artificial samples to train and test an artificial neural network. The artificial network outperformed other models on all measures of accuracy. The results indicated that ML could be used to inform conditions that should be present in a functional analysis. Therefore, this study represents a proof-of-concept for the application of machine learning to functional assessment.

Recent orthopedic surgical literature emphasizes a three-column classification system to understand and guide the treatment of tibial plateau fractures, and incorporating elements from this system into radiology reports will enhance radiologists’ descriptions of these injuries.

The differential diagnosis in patients with calf and posterior ankle pain can span traumatic, metabolic, infectious and inflammatory, congenital, vascular, and neoplastic causes, and knowledge of anatomic principles and characteristic imaging features contributes to accurate and timely diagnosis.

To compare accuracy of ultrasound and MRI for detecting focal peripheral nerve pathology, excluding idiopathic carpal or cubital tunnel syndromes.

Traditional techniques and pedagogies of higher education institutions often fail to provide students with optimal arrangements for learning. Interteaching introduces a beneficial way to arrange learning in the college classroom and mitigates resistance towards earlier behavior analytic educational systems. A multielement design was used to compare three conditions in an undergraduate research methods class: (a) lecture, (b) interteaching with points available for completion of preparation guides, and (c) interteaching with no points provided for the completion of preparation guides. Results showed that interteaching conditions with or without points produced higher quiz scores as compared to lecture. Approximately three times as many students turned in preparation guides when points were available for doing so. Interteaching conditions also lead to higher rates of student participation.

ATRAIDis essential for responses to the commonly prescribed osteoporosis drugs nitrogen-containing bisphosphonates.