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Attention plays an important role in not only the awareness and perception of tinnitus but also its interactions with external sounds. Recent evidence suggests that attention is heightened in the tinnitus brain, likely as a result of relatively local cortical changes specific to deafferentation sites or global changes that help maintain normal cognitive capabilities in individuals with hearing loss. However, most electrophysiological studies have used passive listening paradigms to probe the tinnitus brain and produced mixed results in terms of finding a distinctive biomarker for tinnitus. Here, we designed a selective attention task, in which human adults attended to one of two interleaved tonal (500 Hz and 5 kHz) sequences. In total, 16 tinnitus (5 females) and 13 age- and hearing-matched control (8 females) subjects participated in the study, with the tinnitus subjects matching the tinnitus pitch to 5.4 kHz (range = 1.9-10.8 kHz). Cortical responses were recorded in both passive and attentive listening conditions, producing no differences in P1, N1, and P2 between the tinnitus and control subjects under any conditions. However, a different pattern of results emerged when the difference was examined between the attended and unattended responses. This attention-modulated cortical response was significantly greater in the tinnitus than control subjects: 3.9-times greater for N1 at 5 kHz (95% CI: 2.9 to 5.0, p = 0.007, η p 2 = 0.24) and 3.0 for P2 at 500 Hz (95% CI: 1.9 to 4.5, p = 0.026, η p 2 = 0.17). We interpreted the greater N1 modulation as local neural changes specific to the tinnitus frequency and the greater P2 as global changes to hearing loss. These two cortical measures were used to differentiate between the tinnitus and control subjects, producing 83.3% sensitivity and 76.9% specificity (AUC = 0.81, p = 0.006). These results suggest that the tinnitus brain is more plastic than that of the matched non-tinnitus controls and that the attention-modulated cortical response can be developed as a clinically meaningful biomarker for tinnitus.

Kale is a nutrient-dense leafy vegetable associated with wide-ranging health benefits. It is tolerant of drought and temperature fluctuations, and could thus serve an increasingly important role in providing a safe and nutritious food supply during the climate crisis, while kale's ease of cultivation and ability to be grown in a wide range of soils make it a good fit for urban agriculture. In this pilot study we explored potential differences between kale grown at urban versus rural farms. We planted kale seedlings (Darkibor variety) at three urban and four rural farms in and around Baltimore City, Maryland, instructed farmers to cultivate them using their usual growing practices, harvested the kale from fields and points of distribution, and analyzed it for concentrations of carotenoids, vitamins C and K1, ten nutritional elements, and eight non-essential metals. Although sample sizes for some analyses were in some cases too small to produce statistically significant results, we identified potentially meaningful differences in concentrations of several components between urban and rural kale samples. Compared to urban samples, mean concentrations of carotenoids and vitamins were 22-38% higher in rural field samples. By contrast, mean concentrations for eight nutritional elements were higher in urban field samples by as much as 413% for iron. Compared to rural field samples, mean concentrations of nine non-essential metals were higher in urban samples, although lead and cadmium concentrations for all samples were below public health guidelines. Some urban-rural differences were more pronounced than those identified in prior research. For six elements, variance within urban and rural farms was greater than variance between urban and rural farms, suggesting urbanicity may not be the primary driver of some observed differences. For some nutrients, mean concentrations were higher than upper ranges reported in prior estimates, suggesting kale may have the potential to be more nutrient-dense than previously estimated. The nutritive and metals composition of this important crop, and the factors that influence it, merit continued investigation given its growing popularity., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Urban agriculture is increasingly valued as a strategy for improving quality of life in cities, but urban growers face challenges and often lack coordinated support from governments and the agricultural industry. We surveyed urban growers through an online survey, primarily in the Northeastern United States, to develop a profile of growers and associated organizations, assess the current state of urban agriculture, and determine how universities could help meet their needs. A total of 394 respondents completed the survey and most urban growers were white (non-Hispanic) and younger than 45 years old. Women and men were in almost equal proportion. Urban growers were well-educated, but most did not receive a degree in agriculture. Urban agriculture in our study area was dominated by relatively small non-profit organizations and home and community gardens were the most common types of organizations. Urban agricultural organizations want to improve environmental sustainability and socio-cultural conditions through food access and security, regardless of their tax status. Urban growers face diverse barriers and challenges and the most ubiquitous barriers and challenges reported by respondents were related to availability of land and long-term access in urban areas. Many respondents received low revenue or were operating at a net loss even though they reported diverse income streams. Respondents need a wide range of training, including in traditional agricultural topics as well as financial management and business trainings. Universities can play a key role in promoting urban agriculture by offering training and research. Workforce development is a large priority among universities, so urban growers should regularly be consulted, and the results shared with career and workforce development professionals and researchers in urban areas to identify training and research that meets the needs of stakeholders., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Richardson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: Attempts to use current-focussing strategies with cochlear implants (CI) to reduce neural spread-of-excitation have met with only mixed success in human studies, in contrast to promising results in animal studies. Although this discrepancy could stem from between-species anatomical and aetiological differences, the masking experiments used in human studies may be insufficiently sensitive to differences in excitation-pattern width., Methods: We used an interleaved-masking method to measure psychophysical excitation patterns in seven participants with four masker stimulation configurations: monopolar (MP), partial tripolar (pTP), a wider partial tripolar (pTP + 2), and, importantly, a condition (RP + 2) designed to produce a broader excitation pattern than MP. The probe was always in partial-tripolar configuration., Results: We found a significant effect of stimulation configuration on both the amount of on-site masking (mask and probe on same electrode; an indirect indicator of sharpness) and the difference between off-site and on-site masking. Differences were driven solely by RP + 2 producing a broader excitation pattern than the other configurations, whereas monopolar and the two current-focussing configurations did not statistically differ from each other., Conclusion: A method that is sensitive enough to reveal a modest broadening in RP + 2 showed no evidence for sharpening with focussed stimulation. We also showed that although voltage recordings from the implant accurately predicted a broadening of the psychophysical excitation patterns with RP + 2, they wrongly predicted a strong sharpening with pTP + 2. We additionally argue, based on our recent research, that the interleaved-masking method can usefully be applied to non-human species and objective measures of CI excitation patterns., (© 2024. The Author(s).)

Electrically evoked frequency-following responses (eFFRs) provide insight in the phase-locking ability of brainstem of cochlear-implant (CI) users. eFFRs can potentially be used to gain insight in the individual differences in the biological limitation on temporal encoding of the electrically stimulated auditory pathway, which can be inherent to the electrical stimulation itself and/or the degenerative processes associated with hearing loss. One of the major challenge of measuring eFFRs in CI users is the process of isolating the stimulation artifact from the neural response, as both the response and the artifact overlap in time and have similar frequency characteristics. Here we introduce a new artifact removal method based on template subtraction that successfully removes the stimulation artifacts from the recordings when CI users are stimulated with pulse trains from 128 to 300 pulses per second in a monopolar configuration. Our results show that, although artifact removal was successful in all CI users, the phase-locking ability of the brainstem to the different pulse rates, as assessed with the eFFR differed substantially across participants. These results show that the eFFR can be measured, free from artifacts, in CI users and that they can be used to gain insight in individual differences in temporal processing of the electrically stimulated auditory pathway., (© 2024. The Author(s).)

Objective: To explore how markers of health care disparity are associated with access to care and outcomes among patients seeking and undergoing hysterectomy for benign indications., Data Sources: PubMed, EMBASE, and ClinicalTrials.gov were searched through January 23, 2022., Methods of Study Selection: The population of interest included patients in the United States who sought or underwent hysterectomy by any approach for benign indications. Health care disparity markers included race, ethnicity, geographic location, insurance status, and others. Outcomes included access to surgery, patient level outcomes, and surgical outcomes. Eligible studies reported multivariable regression analyses that described the independent association between at least one health care disparity risk marker and an outcome. We evaluated direction and strengths of association within studies and consistency across studies., Tabulation, Integration, and Results: Of 6,499 abstracts screened, 39 studies with a total of 46 multivariable analyses were included. Having a Black racial identity was consistently associated with decreased access to minimally invasive, laparoscopic, robotic, and vaginal hysterectomy. Being of Hispanic ethnicity and having Asian or Pacific Islander racial identities were associated with decreased access to laparoscopic and vaginal hysterectomy. Black patients were the only racial or ethnic group with an increased association with hysterectomy complications. Medicare insurance was associated with decreased access to laparoscopic hysterectomy, and both Medicaid and Medicare insurance were associated with increased likelihood of hysterectomy complications. Living in the South or Midwest or having less than a college degree education was associated with likelihood of prior hysterectomy., Conclusion: Studies suggest that various health care disparity markers are associated with poorer access to less invasive hysterectomy procedures and with poorer outcomes for patients who are undergoing hysterectomy for benign indications. Further research is needed to understand and identify the causes of these disparities, and immediate changes to our health care system are needed to improve access and opportunities for patients facing health care disparities., Systematic Review Registration: PROSPERO, CRD42021234511., Competing Interests: Financial Disclosure Cara L. Grimes is the research chair for the Society of Gynecologic Surgeons (board position, travel support), Consultant, Provepharm Inc. and she received institutional research support from Reia. Ethan M. Balk received funding from SGS for methodology consultation. Amanda White reports receiving payment from Boston Scientific. Kate Meriwether is the research chair for the Society of Gynecologic Surgeons (board position, travel support). She received book royalties from Elsevier Publishing, has been a consultant for RBI Medical (industry device company, paid position), and received research support from Cook Myosure and Caldera Medical. The other authors did not report any potential conflicts of interest., (Copyright © 2023 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Subungual myxoid cysts and subungual glomus tumors demonstrate characteristic features on magnetic resonance imaging (MRI) and ultrasound (US). It is not yet well-established whether US is congruent to MRI in diagnostic evaluation of these subungual lesions., Methods: Participants with clinical suspicion for subungual glomus tumors or subungual myxoid cysts were recruited. After clinical evaluation, participants underwent radiography, MRI, and US plus biopsy, aspiration, or excision where possible. Differential diagnoses were revised after review of imaging, and imaging findings were compared to definitive diagnosis by pathology, aspiration, or clinical course., Results: All lesions were visible on both US and MRI and size estimates agreed between the two modalities. US and MRI findings of subungual glomus tumors and subungual myxoid cysts agreed with their known respective imaging characteristics., Conclusions: Diagnosis of subungual myxoid cysts and subungual glomus tumors agreed between US and MRI. We provide sample MRI and US imaging parameters for optimal evaluation of subungual myxoid cysts and glomus tumors. We demonstrate that subungual MRI evaluation can be performed without special equipment, allowing for evaluation by most radiology departments. Lastly, US is user-dependent and may be non-inferior for a sonographer familiar with subungual US., Competing Interests: The authors have no conflict of interest to declare. Preliminary findings were reported as an abstract at the Society for Investigative Dermatology 2021 annual meeting (J Invest Dermatol 141 Suppl 1, S79, 2021). The authors report no additional disclosures in relation to this manuscript., (© 2023 The Author(s). Published by S. Karger AG, Basel.)

Climate change models often assume similar responses to temperatures across the range of a species, but local adaptation or phenotypic plasticity can lead plants and animals to respond differently to temperature in different parts of their range. To date, there have been few tests of this assumption at the scale of continents, so it is unclear if this is a large-scale problem. Here, we examined the assumption that insect taxa show similar responses to temperature at 96 sites in grassy habitats across North America. We sampled insects with Malaise traps during 2019-2021 (N = 1041 samples) and examined the biomass of insects in relation to temperature and time of season. Our samples mostly contained Diptera (33%), Lepidoptera (19%), Hymenoptera (18%), and Coleoptera (10%). We found strong regional differences in the phenology of insects and their response to temperature, even within the same taxonomic group, habitat type, and time of season. For example, the biomass of nematoceran flies increased across the season in the central part of the continent, but it only showed a small increase in the Northeast and a seasonal decline in the Southeast and West. At a smaller scale, insect biomass at different traps operating on the same days was correlated up to ~75 km apart. Large-scale geographic and phenological variation in insect biomass and abundance has not been studied well, and it is a major source of controversy in previous analyses of insect declines that have aggregated studies from different locations and time periods. Our study illustrates that large-scale predictions about changes in insect populations, and their causes, will need to incorporate regional and taxonomic differences in the response to temperature., (© 2023 The Authors. Ecology published by Wiley Periodicals LLC on behalf of The Ecological Society of America.)

Most accounts of single- and multi-unit responses in auditory cortex under anesthetized conditions have emphasized V-shaped frequency tuning curves and low-pass sensitivity to rates of repeated sounds. In contrast, single-unit recordings in awake marmosets also show I-shaped and O-shaped response areas having restricted tuning to frequency and (for O units) sound level. That preparation also demonstrates synchrony to moderate click rates and representation of higher click rates by spike rates of non-synchronized tonic responses, neither of which are commonly seen in anesthetized conditions. The spectral and temporal representation observed in the marmoset might reflect special adaptations of that species, might be due to single- rather than multi-unit recording, or might indicate characteristics of awake-versus-anesthetized recording conditions. We studied spectral and temporal representation in the primary auditory cortex of alert cats. We observed V-, I-, and O-shaped response areas like those demonstrated in awake marmosets. Neurons could synchronize to click trains at rates about an octave higher than is usually seen with anesthesia. Representations of click rates by rates of non-synchronized tonic responses exhibited dynamic ranges that covered the entire range of tested click rates. The observation of these spectral and temporal representations in cats demonstrates that they are not unique to primates and, indeed, might be widespread among mammalian species. Moreover, we observed no significant difference in stimulus representation between single- and multi-unit recordings. It appears that the principal factor that has hindered observations of high spectral and temporal acuity in the auditory cortex has been the use of general anesthesia., (© 2023. The Author(s).)

The response to pandemic-related teaching disruption has revealed dynamic levels of learning and teaching flexibility and rapid technology adoption of radiology educators and trainees. Shutdowns and distancing requirements accelerated the adoption of technology as an educational tool, in some instances supplanting in-person education entirely. Despite the limitations of remote interaction, many educational advantages were recognized that can be leveraged in developing distance learning paradigms. The specific strategies employed should match modern learning science, enabling both students and educators to mutually grow as lifelong learners. As panel members of the "COVID: Faculty perspective" Task Force of the Association of University Radiologists Radiology Research Alliance, we present a review of key learning principles which educators can use to identify techniques that enhance resident learning and present an organized framework for applying technology-aided techniques aligned with modern learning principles. Our aim is to facilitate the purposeful integration of learning tools into the training environment by matching these tools to established educational frameworks. With these frameworks in mind, radiology educators have the opportunity to re-think the balance between traditional curricular design and modern digital teaching tools and models., (Copyright © 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

To obtain combined behavioural and electrophysiological measures of pitch perception, we presented harmonic complexes, bandpass filtered to contain only high-numbered harmonics, to normal-hearing listeners. These stimuli resemble bandlimited pulse trains and convey pitch using a purely temporal code. A core set of conditions consisted of six stimuli with baseline pulse rates of 94, 188 and 280 pps, filtered into a HIGH (3365-4755 Hz) or VHIGH (7800-10,800 Hz) region, alternating with a 36% higher pulse rate. Brainstem and cortical processing were measured using the frequency following response (FFR) and auditory change complex (ACC), respectively. Behavioural rate change difference limens (DLs) were measured by requiring participants to discriminate between a stimulus that changed rate twice (up-down or down-up) during its 750-ms presentation from a constant-rate pulse train. FFRs revealed robust brainstem phase locking whose amplitude decreased with increasing rate. Moderate-sized but reliable ACCs were obtained in response to changes in purely temporal pitch and, like the psychophysical DLs, did not depend consistently on the direction of rate change or on the pulse rate for baseline rates between 94 and 280 pps. ACCs were larger and DLs lower for stimuli in the HIGH than in the VHGH region. We argue that the ACC may be a useful surrogate for behavioural measures of rate discrimination, both for normal-hearing listeners and for cochlear-implant users. We also showed that rate DLs increased markedly when the baseline rate was reduced to 48 pps, and compared the behavioural and electrophysiological findings to recent cat data obtained with similar stimuli and methods., (© 2022. The Author(s).)

Objectives: Weight percentiles are generally reported without any indication of error. This variation can lead a fetus being mistakenly classified erroneously as having intrauterine growth restriction (IUGR) or macrosomia. The goal of this study was to compare estimated weight percentiles with the actual observed weight percentile for each gestational age in a large cohort of fetuses being scanned in our institution., Methods: After IRB approval the radiology information system data base was retrospectively searched for all obstetrical US reports obtained during the late second and third trimesters from July 1, 2014, until July 1, 2020. Demographic information, fetal weight, and weight percentile information were obtained from these reports. Quantile-quantile plots were created for all gestational ages and all ethnicities., Results: Our study included 6259 ultrasounds in 4060 patients. Mean maternal age of the total group was 31.68 years (ranging 15-53 years). When all subjects were considered, the median values in our QQ plots approximated the line of identity. However, there was considerable variation for a given estimate, implying that estimated fetal weight percentiles are only very rough predictors of the actual percentile., Conclusion: Estimated fetal weight percentiles are only very rough predictors of the actual percentile. We therefore suggest that estimates of the weight percentile should be reported along with an estimate of the expected variation. Recognition of variations in weight percentile should be considered in the greater clinical context, and could potentially prevent misdiagnosis of growth restriction and macrosomia as well as the subsequent overutilization of resources, unnecessary interventions, and maternal stress., (© 2022 American Institute of Ultrasound in Medicine.)

We describe a scalp-recorded measure of tonotopic selectivity, the "cortical onset response" (COR) and compare the results between humans and cats. The COR results, in turn, were compared with psychophysical masked-detection thresholds obtained using similar stimuli and obtained from both species. The COR consisted of averaged responses elicited by 50-ms tone-burst probes presented at 1-s intervals against a continuous noise masker. The noise masker had a bandwidth of 1 or 1/8th octave, geometrically centred on 4000 Hz for humans and on 8000 Hz for cats. The probe frequency was either - 0.5, - 0.25, 0, 0.25 or 0.5 octaves re the masker centre frequency. The COR was larger for probe frequencies more distant from the centre frequency of the masker, and this effect was greater for the 1/8th-octave than for the 1-octave masker. This pattern broadly reflected the masked excitation patterns obtained psychophysically with similar stimuli in both species. However, the positive signal-to-noise ratio used to obtain reliable COR measures meant that some aspects of the data differed from those obtained psychophysically, in a way that could be partly explained by the upward spread of the probe's excitation pattern. Our psychophysical measurements also showed that the auditory filter width obtained at 8000 Hz using notched-noise maskers was slightly wider in cat than previous measures from humans. We argue that although conclusions from COR measures differ in some ways from conclusions based on psychophysics, the COR measures provide an objective, noninvasive, valid measure of tonotopic selectivity that does not require training and that may be applied to acoustic and cochlear-implant experiments in humans and laboratory animals., (© 2022. The Author(s).)

Cochlear implant (CI) users show limited sensitivity to the temporal pitch conveyed by electric stimulation, contributing to impaired perception of music and of speech in noise. Neurophysiological studies in cats suggest that this limitation is due, in part, to poor transmission of the temporal fine structure (TFS) by the brainstem pathways that are activated by electrical cochlear stimulation. It remains unknown, however, how that neural limit might influence perception in the same animal model. For that reason, we developed non-invasive psychophysical and electrophysiological measures of temporal (i.e., non-spectral) pitch processing in the cat. Normal-hearing (NH) cats were presented with acoustic pulse trains consisting of band-limited harmonic complexes that simulated CI stimulation of the basal cochlea while removing cochlear place-of-excitation cues. In the psychophysical procedure, trained cats detected changes from a base pulse rate to a higher pulse rate. In the scalp-recording procedure, the cortical-evoked acoustic change complex (ACC) and brainstem-generated frequency following response (FFR) were recorded simultaneously in sedated cats for pulse trains that alternated between the base and higher rates. The range of perceptual sensitivity to temporal pitch broadly resembled that of humans but was shifted to somewhat higher rates. The ACC largely paralleled these perceptual patterns, validating its use as an objective measure of temporal pitch sensitivity. The phase-locked FFR, in contrast, showed strong brainstem encoding for all tested pulse rates. These measures demonstrate the cat's perceptual sensitivity to pitch in the absence of cochlear-place cues and may be valuable for evaluating neural mechanisms of temporal pitch perception in the feline animal model of stimulation by a CI or novel auditory prostheses., (© 2022. The Author(s).)

Calcium compounds and vitamin D supplements are readily available as over-the-counter preparations. Whilst integral in maintaining calcium homeostasis in certain patients, excess exogenous intake of these preparations can have deleterious effects, particularly in terms of renal function. We look at the cases of two patients, aged 52 and 34, who were referred into hospital with hypercalcaemia and acute kidney injury (AKI). Both individuals reported regular and prolonged self-medication with unregulated over-the-counter supplements containing calcium carbonate and vitamin D, respectively. Prompt investigation and treatment enabled an element of reversibility of the AKI in both the cases, with further improvement in renal function over time. We emphasise the importance of recognising the overuse of exogenous vitamin D supplements and calcium compounds as rare yet treatable causes of AKI associated with hypercalcaemia and discuss how raising public awareness into the risks posed by self-medication of over-the-counter medicines is paramount.

Rationale and Objectives: Our goal was to create an artificial intelligence (AI) training curriculum for residents that taught them to create, train, evaluate and refine deep learning (DL) models. Hands-on training of models was emphasized and didactic presentations of the mathematical and programmatic underpinnings of DL were minimized., Materials and Methods: We created a three-session, 6-hour curriculum based on a "no-code" machine learning system called Lobe.ai. This class met weekly in June 2021. Pre-class homework included reading assignments, software installation, dataset downloads, and image-collection and labeling. The class sessions included several short, didactic presentations, but were largely devoted to hands-on training of DL models. After the course, our residents completed a short, anonymous, online survey about the course., Results: Our residents learned to acquire and label a wide variety of image datasets. They quickly learned to train DL models to classify these datasets, as well as how to evaluate and refine these models. Our survey showed that most residents felt AI to be important and worth learning, but most were not very interested in learning to program. Most felt that the course taught them useful things about DL, and they were now more interested in the topic. Most would recommend the course to other residents, as well as to medical students and to radiology faculty., Conclusion: The course met our objectives of teaching our residents to create, train, evaluate, and refine DL models. We hope that the hands-on experience they gained in this course will enable them to recognize problems in diagnostic AI systems, and to help solve such problems in their own radiology practices., (Copyright © 2021 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

AI can improve the quality of CT, MR and PET/CT images, while simultaneously reducing imaging time, and doses of radiation and contrast. AI can improve radiologist workflow and decrease interpretation times. AI may someday be capable of accurately locating, classifying and segmenting bone and soft tissue tumors. The goal of radiomics is to use radiomic and other biomarkers to achieve "precision medicine", ie, to predict the right diagnosis and the right treatment of the right patient at the right time. Radiomic information may be helpful in guiding biopsies, classifying and grading tumors and predicting prognosis and treatment response., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: Although racial disparities are well documented for common gynecologic surgical procedures, few studies have assessed racial disparities in the surgical treatment of vaginal prolapse. This study aimed to compare the use of obliterative procedures for the treatment of vaginal prolapse across racial and ethnic groups., Study Design: This is a retrospective cohort study of surgical cases from 2010 to 2018 from the American College of Surgeons National Surgical Quality Improvement Program, a nationally validated database. Cases were identified by Current Procedural Terminology codes. Modified Poisson regression was used to calculate risk ratios and 95% confidence intervals, adjusting for potential confounders selected a priori., Results: We identified 45,865 surgical cases, of which 10% involved an obliterative procedure. In the unadjusted model, non-Hispanic Asian and non-Hispanic Black patients were more likely to undergo an obliterative procedure compared with non-Hispanic White patients (risk ratio [95% confidence interval], 2.4 [2.1-2.7] and 1.2 [1.03-1.3], respectively). These relative risks were largely unchanged when controlling for age, body mass index, diabetes, American Society of Anesthesiologists classification, and concurrent hysterectomy., Conclusions: Although both obliterative and reconstructive procedures have their respective risks and benefits, the proportion of patients undergoing each procedure differs by race and ethnicity. It is unclear whether such disparities may be attributable to differences in preference or inequity in care., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2021 American Urogynecologic Society. All rights reserved.)

Objectives: Electric stimulation is used to treat a number of neurologic disorders such as epilepsy and depression. However, delivering the required current to far-field neural targets is often ineffective because of current spread through low-impedance pathways. Here, the specific aims are to develop an empirical measure for current passing through the human head and to optimize stimulation strategies for targeting deeper structures, including the auditory nerve, by utilizing the cochlear implant (CI)., Materials and Methods: Outward input/output (I/O) functions were obtained by CI stimulation and recording scalp potentials in five CI subjects. Conversely, inward I/O functions were obtained by noninvasive transcranial electric stimulation (tES) and recording intracochlear potentials using the onboard recording capability of the CI., Results: I/O measures indicate substantial current spread, with a maximum of 2.2% gain recorded at the inner ear target during tES (mastoid-to-mastoid electrode configuration). Similarly, CI stimulation produced a maximum of 1.1% gain at the scalp electrode nearest the CI return electrode. Gain varied with electrode montage according to a point source model that accounted for distances between the stimulating and recording electrodes. Within the same electrode montages, current gain patterns varied across subjects suggesting the importance of tissue properties, geometry, and electrode positioning., Conclusion: These results provide a novel objective measure of electric stimulation in the human head, which can help to optimize stimulation parameters that improve neural excitation of deep structures by reducing the influence of current spread., Conflict of Interest: 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., (© 2019 International Neuromodulation Society.)

We deem a computer to exhibit artificial intelligence (AI) when it performs a task that would normally require intelligent action by a human. Much of the recent excitement about AI in the medical literature has revolved around the ability of AI models to recognize anatomy and detect pathology on medical images, sometimes at the level of expert physicians. However, AI can also be used to solve a wide range of noninterpretive problems that are relevant to radiologists and their patients. This review summarizes some of the newer noninterpretive uses of AI in radiology., (Copyright © 2020 The Association of University Radiologists. All rights reserved.)

Artificial intelligence (AI) systems play an increasingly important role in all parts of the imaging chain, from image creation to image interpretation to report generation. In order to responsibly manage radiology AI systems and make informed purchase decisions about them, radiologists must understand the underlying principles of AI. Our task force was formed by the Radiology Research Alliance (RRA) of the Association of University Radiologists to identify and summarize a curated list of current educational materials available for radiologists., (Copyright © 2021. Published by Elsevier Inc.)

Objective: The aim of the study was to determine the effect of increasing age on postoperative admission, readmission, and complications for patients 60 years and older who underwent a synthetic or autologous sling procedure for stress incontinence., Methods: A retrospective cohort study of surgical cases from 2012 to 2017 from the American College of Surgeons National Surgical Quality Improvement Program database was conducted. Eligible patients were at least 60 years old and underwent an isolated sling procedure for stress incontinence identified by Current Procedural Terminology code 57288. Baseline demographics, preoperative comorbidities, and postoperative complications were obtained. Risk ratios (RRs) and 95% confidence intervals were calculated using log-binomial regressions., Results: Of 3,960 eligible patients, 634 (16.0%) were admitted postoperatively. Admission rates differed across age groups (P = 0.04). For example, compared with patients aged 60-64 years, those aged 70-74 years had 1.3 times the risk of admission (95% confidence interval, 1.04-1.6). Other risk factors for admission included diabetes (RR, 1.3) and hypertension (RR, 1.2). Patients who had general anesthesia had 6.3 times the risk of admission compared with those who had monitored anesthesia/intravenous sedation. There were 72 patients (1.8%) readmitted within 30 days. There was no association between age and readmission. Risk factors for readmission included diabetes (RR, 1.8), bleeding disorders (RR, 3.4), severe chronic obstructive pulmonary disease (RR, 3.7), and congestive heart failure (RR, 11.3). There were 192 complications (4.8%), including 45 major complications (1.1%)., Conclusions: Among patients 60 years and older, the risk of postoperative admission and readmission for patients undergoing a synthetic or autologous sling procedure is low and complications are uncommon., Competing Interests: A.M.M. is a paid statistical consultant for Tissue Regenix and Renovia, Inc. Money has been paid to her institution from the Koch Foundation, and she has a financial relationship with ABC Board Review. The other authors have declared they have no conflicts of interest., (Copyright © 2020 American Urogynecologic Society. All rights reserved.)

Ethnopharmacological Relevance: Hibiscus species (Family: Malvaceae) have long been used in traditional medicine to treat a variety of maladies such as abscesses, bilious conditions, cancer, cough, fatigue, gastrointestinal discomfort, fever, veisalgia, cardiovascular disorders, neurosis, scurvy, and urinary tract disorders. Its antioxidants have the capacity to destroy free radicals that damage cells and increase risk of inflammatory conditions such as metabolic syndrome, cancer, and cardiovascular disease., Aim of the Study: This review synthesizes findings from animal studies and clinical trials to assess effectiveness of hibiscus for treating biomarkers of metabolic syndrome including hyperglycemia, hypertriglyceridemia, low high-density lipoprotein, obesity, and hypertension., Materials and Methods: We searched for 12 edible species of hibiscus in the Google Scholar database. Each scientific name of these species, their common names and their edible plant parts were searched in conjunction with fourteen key words associated with metabolic syndrome. A total of 68 articles met all inclusion criteria for this review, including 18 that tested human subjects, 48 that tested other animals, one that tested humans and other animals, and one that did not specify., Results: Hibiscus often improved blood glucose, total cholesterol, high-density lipoprotein cholesterol, triglycerides, blood pressure, weight, lipid absorption and oxidation of fatty acids within vital organs around the abdominal cavity. Higher doses led to greater benefits in some cases, especially for body mass of animals, but lower doses were often equally effective. Hibiscus was often equally or more effective than pharmaceuticals in improving some biomarkers of metabolic syndrome, especially blood glucose and insulin sensitivity., Conclusion: Hibiscus shows great promise for improving biomarkers of metabolic syndrome, but there are limitations that need to be addressed by future work, including increasing the number and size of human clinical trials, expanding human trials to include people from a greater diversity of ethnicities, taking into account the health and physical activity of human participants, investigating the influence of growing conditions and extraction/preparation techniques on nutrients in hibiscus, comparing the efficacy of several plant parts and plant products of hibiscus to a reference control group within the same experiment, incorporating rigorous statistical analysis of treatments and investigating the influence of dosage., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: COVID-19 has taken its toll on citizens in all 50 states of the United States. The United States (U.S.) leads the world with 30,291,863 confirmed reported cases and 549,664 deaths as of March 29, 2021 compared to globally confirmed cases at 127,442,926 and 2,787,915 deaths as of March 29, 2021. The U.S. federal government primarily left the response to the virus to individual states, and each implemented varying measures designed to protect health of citizens and the state's economic well-being. Unintended consequences of the virus and measures to stop its spread may include decreased physical activity and exercise, shifting access and consumption of food, and lower quality-of-life. Therefore, our primary goal was to quantify the impact of COVID-19 on health and well-being by measuring changes in physical activity, mental health-quality of life, food security and nutrition in adults ages 40 and older. We believed shifts in health behaviors would be more prevalent in minorities, less educated, lower socio-economic status, older adults, and those with underlying health conditions, so a secondary goal was to determine the impact of COVID-19 on these sub-populations., Methods: We conducted an online survey with 9969 adults 40 years and older between 9 August and 15 September 2020 in urban areas across the four U.S. census regions. The survey included questions about demographic variables, pre-existing health conditions, physical activity, access to food, quality-of-life, and nutritional food status and asked participants to respond with information from pre-pandemic and pandemic conditions. We used paired-sample t-tests to detect changes in variables after the start of the pandemic and Cohen's d to determine effect sizes., Results: Our main findings showed a decrease in physical activity since the onset of COVID-19 for minorities and non-minorities. Food security also slightly increased for minorities during the pandemic, but we found no other changes in food security, quality-of-life indicators, or nutritional status of those who responded to this survey., Conclusions: It is concerning that physical activity declined. Such activity helps maintain physical and mental health, and it is also an important time to socialize for many older adults. In many ways, our data indicate that the older adult population in U.S. cities may be more resilient than expected during the pandemic. However, the pandemic could have negative impacts that we did not detect, either due to the survey instrument or the timing of our survey, so the health and well-being of older adults should continue to be monitored in order to mitigate potential negative impacts.

Introduction : In controversial fashion, the presence of an enlarged external occipital protuberance has been recently linked to excessive use of handheld electronic devices. We sought to determine the prevalence of this protuberance in a diverse age group of adults from two separate time periods, before and approximately 10 years after the release of the iPhone, to further characterize this theory, as if indeed valid, such a relationship could direct preventative behavior. Materials and Methods : Eighty-two cervical spine radiographs between March 7, 2007 through June 29, 2007 and 147 cervical spine radiographs between October 25, 2017 through January 1, 2018 were reviewed for the presence or absence of an exophytic external occipital protuberance. Influence of sex and age were also assessed. Results : There were 41/82 (50%) patients within the 2007 pre-iPhone group with an exophytic external occipital protuberance, ranging from 2.7-33.8 mm in length. Twenty-seven out of 82 (32.9%) had an external occipital protuberance at or above 10 mm. There were 49/147 (33.3%) patients within the 2017 post-iPhone group with an exophytic external occipital protuberance, ranging from 4.4-53.8 mm in length. Thirty-three out of 147 (22.4%) had an external occipital protuberance at or above 10 mm. When considering accessibility to the iPhone, sex, and age to the presence of an exophytic external occipital protuberance, only sex has a statistically significant association, p=0.000000033. Conclusion : We found no significant association with iPhone accessibility and an exophytic external occipital protuberance. Due to inherent limitations in the retrospective nature of the study, future research is needed to better examine the association of handheld electronic devices with exophytic external occipital protuberances., (Copyright ©2021, Yale Journal of Biology and Medicine.)

Purpose: This study was performed to demonstrate that a properly trained convolutional neural net (CNN) can provide an acceptable surrogate for human readers when performing a protocol optimization study. Tears of the anterior cruciate ligament (ACL) were used as a proof of concept for this study., Methods: Following institutional review board approval, a curated set of 2007 paired knee MR images was extracted from the author's picture archival and communications system for 1523 normal knees and 484 knees with torn ACLs. A pair (1 fat-saturated (FS) and 1 non-fat-saturated (NFS)) of midline sagittal images was extracted from each knee. CNNs were trained for both the FS and NFS image sets and used to make predictions on a previously unseen test set of images., Results: Receiver operating characteristic area under the curve for the NFS and FS CNNs were, respectively, 0.9983 and 0.9988. Specificity was identical (0.993) for both NFS and FS images. FS sensitivity (0.98) and NFS sensitivity (0.88) were statistically significantly different (P = 0.0253)., Conclusions: Both FS and NFS performed very well for the diagnosis of ACL tears, although FS sensitivity was superior to NFS sensitivity. The CNNs provided an acceptable surrogate for a human reader in this study. Pulse sequence optimization studies such as this can be opportunistically performed on image sets collected for many other machine learning purposes., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: The aim of the study was to understand the surgical trends and 30-day complications of patients undergoing an abdominal sacrocolpopexy with a concurrent hysterectomy., Methods: This is a retrospective cohort study of surgical cases from the American College of Surgeons National Surgical Quality Improvement Program from 2010 to 2017 who underwent an abdominal sacrocolpopexy and a concurrent hysterectomy., Results: There were 9327 surgical cases of an abdominal sacrocolpopexy with a concurrent hysterectomy of which 7772 (83.3%) were minimally invasive and 1555 (16.7%) were through a laparotomy. The proportion of patients undergoing a laparotomy decreased by 2.4% per year from 2010 to 2018 (R2 = 0.77). Among minimally invasive procedures, 4359 (46.7%) involved a concurrent supracervical hysterectomy and 4968 (53.3%) involved a concurrent total hysterectomy. Among minimally invasive procedures, patients who had a concurrent supracervical hysterectomy both had a longer operative time and were more likely to be admitted at least 2 days postoperatively compared with those who had a concurrent total hysterectomy (P < 0.001 for both)., Conclusions: Patients undergoing an abdominal sacrocolpopexy and concurrent hysterectomy are increasingly likely to undergo surgery in a minimally invasive approach. The Food and Drug Administration safety communication on electric power morcellation did not impact this trend. Although complication rates are low, regardless of the type of concurrent hysterectomy, some complications, such as blood transfusions and surgical site infections, seem to be highest for those undergoing a concurrent total hysterectomy despite the fact that a concurrent supracervical hysterectomy may be associated with a longer operative time and longer hospital admission., Competing Interests: A.M.M. is a paid statistical consultant for Tissue Regenix and Renovia Inc. The other authors have declared they have no conflicts of interest., (Copyright © 2020 American Urogynecologic Society. All rights reserved.)

Rationale and Objectives: Peer learning is a case-based group-learning model intended to improve performance. In this descriptive paper, we describe multi-institutional, multi-subspecialty, web-based radiology case conferences and summarize the participants' experiences., Materials and Methods: A semi-structured, 27-question survey was administered to radiologists participating in abdominal, cardiothoracic, and musculoskeletal case conferences. Survey questions included demographics, perceived educational value and challenges experienced. Survey question formats were continuous, binary, five-point Likert scale or text-based. The measures of central tendencies, proportions of responses and patterns were tabulated., Results: From 57 responders, 12/57 (21.1%) were abdominal, 16/57 (28.1%) were cardiothoracic, and 29/57 (50.8%) were musculoskeletal conference participants; 50/56 (89.3%) represented academic practice. Median age was 45 years (range 35-74); 43/57 (75.4%) were male. Geographically, 16/52 (30.8%) of participants were from the East Coast, 16/52 (30.8%) Midwest, 18/52 (34.6%) West Coast, and 2/52 (3.8%) International. The median reported educational value was 5/5 (interquartile range 5-5). Benefits of the case conference included education (50/95, 52.6%) and networking (39/95, 41.1%). Participants reported presenting the following cases: "great call" 32/48 (66.7%), learning opportunity 32/48 (66.7%), new knowledge 41/49 (83.7%), "zebras" 46/49 (93.9%), and procedural-based 16/46 (34.8%). All 51/51 (100%) of responders reportedly gained new knowledge, 49/51 (96.1%) became more open to group discussion, 34/51 (66.7%) changed search patterns, and 50/51 (98%) would continue to participate. Reported challenges included time zone differences and support from departments for a protected time to participate., Conclusion: Peer learning through multi-institutional case conferences provides educational and networking opportunities. Current challenges and desires include having department-supported protected time and ability to receive continuing medical education credit., (Copyright © 2019 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Objective: Our purpose was to assess the calibration of resident, fellow, and attending radiologists on a simple image classification task (presence or absence of an anterior cruciate ligament [ACL] tear based on interpretation of sagittal proton density, fat-saturated MR images) and to assess whether teaching residents could improve their calibration., Methods: We created a test containing 30 randomized, sagittal, proton density, fat-saturated MR images of the ACL (15 normal, 15 torn). This test was administered in person to 20 trainees and 3 attendings at one medical center in one state. An online version of the test was given to 23 trainees and 14 attendings from 11 other medical centers in nine other states. Subjects were asked to give their confidence level (0%-100%) that each ACL was torn., Results: Cross-sectional data were collected from 60 radiologists (mean time after medical school = 9.3 years, minimum = 1 year, maximum = 36 years). This demonstrated a statistically significant improvement in calibration as a function of increasing experience (P = .020). Longitudinal data were collected from 12 trainees at the start and end of their musculoskeletal radiology rotation, with an intervening review of the primary and secondary signs of ACL tear on MR. A statistically significant improvement in calibration was noted during the rotation (P = .028)., Conclusions: Confidence calibration is a promising tool for quality improvement and radiologist self-assessment. Our study showed that calibration loss improves with experience in radiologists tested on a common and clinically important image classification task. We also demonstrated that calibration can be successfully taught to residents over a relatively short period (2-4 weeks)., (Copyright © 2020 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Hip microinstability is a recognized cause of hip pain in young patients. Intra-operative evaluation is used to confirm the diagnosis, but limited data exist associating magnetic resonance arthrography (MRA) findings with hip microinstability. To determine if a difference exists in the thickness of the anterior joint capsule and/or the width of the anterior joint recess on MRA in hip arthroscopy patients with and without an intra-operative diagnosis of hip laxity. Sixty-two hip arthroscopy patients were included in the study. Two musculoskeletal radiologists blinded to surgical results reviewed the MRAs for two previously described findings: (i) anterior joint capsule thinning; (ii) widening of the anterior joint recess distal to the zona orbicularis. Operative reports were reviewed for the diagnosis of joint laxity. In all patients with and without intra-operative laxity, there were no significant differences with either MRA measurement. However, twenty-six of 27 patients with intra-operative laxity were women compared with 11 of 35 patients without laxity ( P  < 0.001). In subgroup analysis of women, the intra-operative laxity group had a higher rate of capsular thinning compared with the non-laxity group (85% versus 45%; P  = 0.01). A 82% of women with capsular thinning also had intra-operative laxity, compared with 40% without capsular thinning ( P  = 0.01). There were no differences regarding the width of the anterior joint recess. In this study, there was an association between capsular thinning and intra-operative laxity in female patients. Measuring anterior capsule thickness on a pre-operative MRA may be useful for the diagnosis of hip microinstability., (© The Author(s) 2020. Published by Oxford University Press.)

Objective: To understand the compensation differences between male and female academic urogynecologists at public institutions., Methods: Urogynecologists at public universities with publicly available salary data as of June 2019 were eligible for the study. We collected characteristics, including sex, additional advanced degrees, years of training, board certification, leadership roles, number of authored scientific publications, and total National Institutes of Health funding projects and number of registered clinical trials for which the physician was a principal or co-investigator. We also collected total number of Medicare beneficiaries treated and total Medicare reimbursement as reported by the Centers for Medicare & Medicaid Services. We used linear regression to adjust for potential confounders., Results: We identified 85 academic urogynecologists at 29 public state academic institutions with available salary data eligible for inclusion in the study. Males were more likely to be an associate or a full professor (81%) compared with females (55%) and were more likely to serve as department chair, vice chair, or division director (59%) compared with females (30%). The mean annual salary was significantly higher among males ($323,227 ± $97,338) than females ($268,990 ± $72,311, P = 0.004). After adjusting for academic rank and leadership roles and years since residency, the discrepancy persisted, with females compensated on average $37,955 less annually., Conclusions: Salaries are higher for male urogynecologists than female urogynecologists, even when accounting for variables such as academic rank and leadership roles. Physician compensation is complex; the differences observed may be due to variables that are not captured in this study. Nevertheless, the magnitude of disparity found in our study warrants further critical assessment of potential biases within the field.

A probabilistic forecast is one that assigns a probability (or likelihood) to the occurrence of an event. Radiologists commonly make probabilistic judgments in their reports, even if these predictions are not explicitly expressed as numbers. There are calls for radiologists to commit to their probabilistic predictions in a standardized fashion; however, without a mechanism for feedback, there is no opportunity for improvement. Analysis techniques familiar to radiologists (eg, calculation of sensitivity and specificity and construction of receiver operating characteristics curves) have a blind spot with regard to calibration of these probabilities to reality and are the main obstacle to improvement along this axis. We review statistical and graphical methods for calibration analysis in wider use outside the medical literature and present a framework for implementation of these techniques for quality improvement and radiologist self-assessment., (Copyright © 2019 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

An audience response system (ARS) is an excellent tool for improving interactive learning in radiology residents. Traditional ARSs have long allowed text-based interactions between teacher and students. However, little attention has been given to techniques which allow students in large groups to interact directly with an image. Fortunately, a growing number of ARSs are beginning to add this ability. However, it is not the technology but the pedagogy that matters the most. The purpose of this article is to review those ARSs, and to present an array of pedagogical techniques that can take advantage of this technology., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: Rheumatoid arthritis (RA) often ameliorates during pregnancy and flares postpartum, but the relationship of pregnancy and childbirth to RA prognosis is unclear. We examined RA severity for association with parity prior to RA onset and asked whether time from birth (latency) and/or the mother's HLA genotype influenced results., Methods: A cohort study was conducted of 222 women previously identified in a prospective study of newly diagnosed RA, who returned for follow-up evaluation a median of 8 years later. Stratified analyses using Mantel-Haenszel methods were conducted to evaluate 5 RA severity measures based on hand and wrist radiographs, physical exams, and Health Assessment Questionnaires for association with parity., Results: Overall, we observed little evidence of altered risk of progression to severe RA in relation to pre-onset parity, adjusting for RA onset age and time to follow-up. Stratifying parous women who had only live births by latency (<15 years/15+ years) showed no difference in risk of severe RA compared to nulligravid women. Live birth deliveries were significantly protective for women with 0 but not for those with 1 or 2 copies of the RA risk-associated HLA-DRB1 shared epitope sequence for erosion score (RR 0.26 95% CI 0.09-0.89) and joint count (RR 0.28 95% CI 0.09-0.87)., Conclusion: We observed little evidence of difference in severe RA by pre-onset parity overall. However, among women not predisposed to RA by possessing the risk-associated HLA genotype, parous women who had only live births had lower risk of progression to severe RA as measured by erosion score and joint count., (Copyright © 2019 Elsevier Inc. All rights reserved.)