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Health care organizations are building, deploying, and self-governing digital health technologies (DHTs), including artificial intelligence, at an increasing rate. This scope necessitates expertise and quality infrastructure to ensure that the technology impacting patient care is safe, effective, and ethical throughout its lifecycle. The objective of this article is to describe Mayo Clinic’s approach for embedding internal accountability as a case study for other health care institutions seeking modalities for responsible implementation of artificial intelligence–enabled DHTs. Mayo Clinic aims to enable and empower innovators by (1) building internal skills and expertise, (2) establishing a centralized review board, and (3) aligning development and deployment processes with regulations, standards, and best practices. In 2022, Mayo Clinic established the Software as a Medical Device Review Board (The Board), an independent body of physicians and domain experts to represent the organization in providing innovators regulatory and risk mitigation recommendations for DHTs. Hundreds of digital health product teams have since benefited from this function, intended to enable responsible innovation in alignment with regulation and state-of-the-art quality management practices. Other health care institutions can adopt similar internal accountability bodies using this framework. Opportunity remains to iterate on Mayo Clinic’s approach in alignment with advancing best practices and enhance representation on The Board as part of standard continuous improvement practices.

Background: Centering equity in evaluations is increasingly recognized as an important professional responsibility of evaluators. While some theoretical and practical guidance exists, the evaluation field has limited empirical research on equity within evaluation practice. Purpose: This paper explores whether and how evaluators address inequities and advance equity throughout evaluation phases drawing on select findings from a larger study. Setting: The study focuses on American Evaluation Association-affiliated evaluators in the New England region of the United States who work in a variety of areas (e.g., health, education). Intervention: Not applicable Research Design: The study uses a complementarity, sequential mixed methods design comprised of a researcher-developed online questionnaire administered to a census and snowball sample of practicing evaluators (n=82) and individual, semi-structured interviews with a subset of this sample selected to maximize variation (n=21). Quantitative data were analyzed using descriptive statistics (i.e., means and standard deviations, frequencies). Qualitative data were analyzed using a collaborative process of deductive and inductive coding followed by thematic analysis. Findings: Eight overarching findings suggest that despite evaluators’ attempts to center equity, it remains largely “on the sideline.” This is due to evaluators’ need to work against some conventional professional and methodological norms, within contractual and contextual constraints, and with limited professional preparation.

Purpose: Electrocardiogram-gated computed tomography with coronary angiography can be used for cardiac substructure sparing (CSS) optimization, which identifies and improves avoidance of cardiac substructures when treating with intensity modulated radiotherapy (IMRT). We investigated whether intensity modulated proton therapy (IMPT) would further reduce dose to cardiac substructures for patients with mediastinal lymphoma. Patients and Methods: Twenty-one patients with mediastinal lymphoma were enrolled and underwent electrocardiogram-gated computed tomography angiography during or shortly after simulation for radiotherapy planning. Thirteen patients with delineated cardiac substructures underwent comparative planning with both IMPT and IMRT. Plans were normalized for equivalent (95%) target volume coverage for treatment comparison. Results: Thirteen patients met criteria for this study. The median size of the mediastinal lymphadenopathy was 7.9 cm at the greatest diameter. Compared with IMRT-CSS, IMPT-CSS significantly reduced mean dose to all cardiac substructures, including 3 coronary arteries and 4 cardiac valves. Use of IMPT significantly reduced average whole-heart dose from 9.6 to 4.9 Gy (P < .0001), and average mean lung dose was 9.7 vs 5.8 Gy (P < .0001). Prospectively defined clinically meaningful improvement was observed in at least 1 coronary artery in 9 patients (69%), at least 1 cardiac valve in 10 patients (77%), and whole heart in all 13 patients. Conclusions: For patients with mediastinal lymphoma, IMPT-CSS treatment planning significantly reduced radiation dose to cardiac substructures. The significant improvements outlined in this study for proton therapy suggest possible clinical improvement in alignment with previous analyses of CSS optimization.

Muscle protein is constantly “turning over” through the breakdown of old/damaged proteins and the resynthesis of new functional proteins, the algebraic difference determining net muscle gain, maintenance, or loss. This turnover, which is sensitive to the nutritional environment, ultimately determines the mass, quality, and health of skeletal muscle over time. Intermittent fasting has become a topic of interest in the health community as an avenue to improve health and body composition primarily via caloric deficiency as well as enhanced lipolysis and fat oxidation secondary to attenuated daily insulin response. However, this approach belies the established anti-catabolic effect of insulin on skeletal muscle. More importantly, muscle protein synthesis, which is the primary regulated turnover variable in healthy humans, is stimulated by the consumption of dietary amino acids, a process that is saturated at a moderate protein intake. While limited research has explored the effect of intermittent fasting on muscle-related outcomes, we propose that infrequent meal feeding and periods of prolonged fasting characteristic of models of intermittent fasting may be counter-productive to optimizing muscle protein turnover and net muscle protein balance. The present commentary will discuss the regulation of muscle protein turnover across fasted and fed cycles and contrast it with studies exploring how dietary manipulation alters the partitioning of fat and lean body mass. It is our position that intermittent fasting likely represents a suboptimal dietary approach to remodel skeletal muscle, which could impact the ability to maintain or enhance muscle mass and quality, especially during periods of reduced energy availability.

Summary: The TAM receptor, Axl, has been implicated as a candidate entry receptor for Zika virus (ZIKV) infection but has been shown as inessential for virus infection in mice. To probe the role of Axl in murine ZIKV infection, we developed a mouse model lacking the Axl receptor and the interferon alpha/beta receptor (Ifnar−/−Axl−/−), conferring susceptibility to ZIKV. This model validated that Axl is not required for murine ZIKV infection and that mice lacking Axl are resistant to ZIKV pathogenesis. This resistance correlates to lower pro-interleukin-1β production and less apoptosis in microglia of ZIKV-infected mice. This apoptosis occurs through both intrinsic (caspase 9) and extrinsic (caspase 8) manners, and is age dependent, as younger Axl-deficient mice are susceptible to ZIKV pathogenesis. These findings suggest that Axl plays an important role in pathogenesis in the brain during ZIKV infection and indicates a potential role for Axl inhibitors as therapeutics during viral infection. : Biological Sciences; Neurotoxicology; Virology Subject Areas: Biological Sciences, Neurotoxicology, Virology

No study has concurrently measured changes in free-living whole body protein metabolism and exercise performance during recovery from an acute bout of resistance exercise. We aimed to determine if whey protein ingestion enhances whole body net protein balance and recovery of exercise performance during overnight (10 h) and 24 h recovery after whole body resistance exercise in trained men. In a double-blind crossover design, 12 trained men (76 ± 8 kg, 24 ± 4 years old, 14% ± 5% body fat; means ± standard deviation (SD)) performed resistance exercise in the evening prior to consuming either 25 g of whey protein (PRO; MuscleTech 100% Whey) or an energy-matched placebo (CHO) immediately post-exercise (0 h), and again the following morning (~10 h of recovery). A third randomized trial, completed by the same participants, involving no exercise and no supplement served as a rested control trial (Rest). Participants ingested [15N]glycine to determine whole body protein kinetics and net protein balance over 10 and 24 h of recovery. Performance was assessed pre-exercise and at 0, 10, and 24 h of recovery using a battery of tests. Net protein balance tended to improve in PRO (P = 0.064; effect size (ES) = 0.61, PRO vs. CHO) during overnight recovery. Over 24 h, net balance was enhanced in PRO (P = 0.036) but not in CHO (P = 0.84; ES = 0.69, PRO vs. CHO), which was mediated primarily by a reduction in protein breakdown (PRO < CHO; P < 0.01. Exercise decreased repetitions to failure (REP), maximal strength (MVC), peak and mean power, and countermovement jump performance (CMJ) at 0 h (all P < 0.05 vs. Pre). At 10 h, there were small-to-moderate effects for enhanced recovery of the MVC (ES = 0.56), mean power (ES = 0.49), and CMJ variables (ES: 0.27–0.49) in PRO. At 24 h, protein supplementation improved MVC (ES = 0.76), REP (ES = 0.44), and peak power (ES = 0.55). In conclusion, whey protein supplementation enhances whole body anabolism, and may improve acute recovery of exercise performance after a strenuous bout of resistance exercise.

We present a case of fetoplacental discrepancy in a second-trimester fetus with normal karyotype in amniotic fluid and two different Robertsonian translocations in placenta. A 41-year-old woman of Middle-Eastern origin, gravida 2, para 1, underwent amniocentesis at 16-week gestation because of advanced maternal age. Amniotic fluid karyotype showed a normal 46,XX karyotype with a homozygous inv(9). Parental chromosome analysis showed both parents to be carriers of inv(9) and the parents are not consanguineous. Fetal ultrasound was normal. The mother presented to the clinic 4 weeks later with intrauterine fetal demise. Chromosome analysis from the placenta showed two different cell lines: a balanced (15;21) Roberstonian translocation in 11 cells and an unbalanced (21;21) Robertsonian translocation in 9 cells. The karyotype was interpreted as mos 45,XX,inv(9)(p11q13)x2,der(15;21)(q10;q10)[11]/46,XX,inv(9)(p11q13)x2,+21,der(21;21)(q10;q10). Mother was a carrier for the Cystic Fibrosis (delta F508), Factor V Leiden mutations, HbD-Los Angeles and HbQ-India variants. She also had a sibling with term stillbirth. Her husband’s history was unremarkable. Our case appears to be another example of confined placental mosaicism (CPM) with normal fetal karyotype. However, we could not confirm the possibility that CPM contributed to the IUFD in our case given the complex medical history of the mother.

Abstract Purpose  Macroscopic focal fat deposition within the wall of the right ventricle (RV) has been historically associated with arrhythmogenic right ventricular dysplasia (ARVD). We attempt to characterize the incidence of macroscopic RV fat detected as an incidental imaging finding on electron beam computer tomography (EBCT). Methods  A total of 165 patients were imaged. Their electronic medical records and imaging studies were reviewed for age, gender, body-mass index, the presence of focal fat in the RV wall, and additional thoracic fatty proliferation. Results  A set of 28 patients (17%) had macroscopic fat along the RV wall. The mean age of the patients with fatty deposition was 58.6 ± 9.9, compared with 54.4 ± 9.9 for patients without it. The difference in incidence of the finding by mean age was statistically significant (P-value = 0.045). When grouped according to their Body Mass Index (BMI), there was no statistical association between the BMI category and the presence of focal fat deposition (P = 0.23). Conclusion  Macroscopic fatty deposition of the RV wall is a common incidental imaging finding in up to 17% of patients that increases in prevalence as age advances. [ABSTRACT FROM AUTHOR]