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The COVID-19 pandemic dramatically disrupted health care systems and delivery in the United States. Despite emotional, psychological, logistical, and financial stress, primary care clinicians responded to the challenges that COVID-19 presented and continued to provide essential health services to their communities. As the lead federal agency for primary care research, the Agency for Healthcare Research and Quality (AHRQ) identified a need to engage and support primary care in responding to COVID-19. AHRQ initiated a learning community from December 2020-November 2021 to connect professionals and organizations that support primary care practices and clinicians. The learning community provided a forum for participants to share learning and peer support, better understand the stressors and challenges confronting practices, ascertain needs, and identify promising solutions in response to the pandemic. We identified challenges, responses, and innovations that emerged through learning community engagement, information sharing, and dialog. We categorized these across 5 domains that reflect core areas integral to primary care delivery: patient-centeredness, clinician and practice, systems and infrastructure, and community and public health; health equity was crosscutting across all domains. The engagement of the community to identify real-time response and innovation in the context of a global pandemic has provided valuable insights to inform future research and policy, improve primary care delivery, and ensure that the community is better prepared to respond and contribute to ongoing and future health challenges.

As it begins to enter the clinic, regenerative medicine has the potential to revolutionize healthcare. Although there exists a growing need for individuals well-versed in the practice of regenerative medicine, few undergraduate institutions offer opportunities to learn about the topic. This article highlights the conception of two novel undergraduate courses in regenerative medicine developed through collaboration between students and faculty at our University to fill this void in the undergraduate curriculum. Lectures from scientists, healthcare professionals, regulatory experts and biotechnology leaders introduced students to regenerative medicine research and the translational process, and a certificate program incorporating relevant coursework and research experience is in development. This pipeline will guide promising undergraduate students to the field of regenerative medicine.Regenerative medicine is a new medical discipline that aims to restore diseased or damaged tissue back to a healthy state. Stem cells, gene therapies and other regenerative approaches are now being used to treat patients, and, as a result, the field has recently entered the public eye. To implement these cutting-edge therapies, a well-trained workforce is required; however, regenerative medicine education, especially at the undergraduate level, is currently lacking. Faculty and students at our University worked together to address this issue by creating educational offerings that expose undergraduates to the work being done in the field, and opening opportunities for help them to engage in regenerative medicine-related research. Expanded utilization of this approach will encourage talented undergraduates to contribute to the development of safe, effective regenerative therapies.

Integrating primary care with the health response is key to managing pandemics and other health emergencies. In recognition of this, the Australian Government established a network of respiratory clinics led by general practitioners in response to the coronavirus disease 2019 (COVID-19) pandemic as part of broader measures aimed at supporting primary care. General practitioner (GP) respiratory clinics provide holistic face-to-face assessment and treatment to those with respiratory symptoms in an environment with strict protocols for infection prevention and control. This ensures that these patients are able to access high quality primary care while protecting the general practice workforce and other patients. The GP respiratory clinic model was developed and operationalized 10 days after the policy was announced, with the first 2 respiratory clinics opening on March 21, 2020. Subsequently a total of 150 respiratory clinics were opened and served over 800,000 patients within more than 99% of Australia's postcodes. These clinics used a standardized data collection tool that has provided the largest and most complete primary care surveillance database of respiratory illness in Australia. The success of the GP respiratory clinic model was made possible due to strong partnerships with Primary Health Networks and individual general practices that rapidly shifted operations to embrace this new approach. This article describes the development and early implementation of this model.

Despite frequent reports of imaging artificial intelligence (AI) that parallels human performance, clinicians often question the safety and robustness of AI products in practice. This work explores two underreported sources of noise that negatively affect imaging AI: (a) variation in labeling schema definitions and (b) noise in the labeling process. First, the overlap between the schemas of two publicly available datasets and a third-party vendor are compared, showing there is low agreement ( 90%). Among low agreement classes (pneumonia, consolidation), the labels assigned as “ground truth” were unreliable, suggesting that the result of majority voting is highly dependent on which group of radiologists is assigned to annotation. Noise in labeling schemas and gold label annotations are pervasive in medical imaging classification and affect downstream clinical deployment. Possible solutions (eg, changes to task design, annotation methods, and model training) and their potential to improve trust in clinical AI are discussed. Keywords: Radiology AI, Dataset Creation, Noise in Datasets Supplemental material is available for this article. © RSNA, 2023 See also the commentary by Ursprung and Woitek in this issue.

The discovery of haplotypes with unknown or uncertain function in the CYP2D6 pharmacogene is outpacing the capabilities of traditional in vitro and in vivo approaches to characterize their function. This challenge will undoubtedly grow as pharmacogenomic research becomes more inclusive of globally diverse populations. As accurate phenotypic assignment is paramount to the utility of pharmacogenomics, high-throughput technologies are needed for this complex pharmacogene. We describe the evolving landscape of innovative approaches to assign function to CYP2D6 haplotypes and possibilities for adopting these technologies into cohesive processes. Promising approaches include ADME-optimized prediction frameworks, machine learning algorithms, deep mutational scanning and phenoconversion predictions. Implementing these approaches will lead to improved personalization of treatment for patients.

Implementation of artificial intelligence (AI) applications into clinical practice requires AI-savvy radiologists to ensure the safe, ethical, and effective use of these systems for patient care. Increasing demand for AI education reflects recognition of the translation of AI applications from research to clinical practice, with positive trainee attitudes regarding the influence of AI on radiology. However, barriers to AI education, such as limited access to resources, predispose to insufficient preparation for the effective use of AI in practice. In response, national organizations have sponsored formal and self-directed learning courses to provide introductory content on imaging informatics and AI. Foundational courses, such as the National Imaging Informatics Course - Radiology and the Radiological Society of North America Imaging AI Certificate, lay a framework for trainees to explore the creation, deployment, and critical evaluation of AI applications. This report includes additional resources for formal programming courses, video series from leading organizations, and blogs from AI and informatics communities. Furthermore, the scope of "AI and radiology education" includes AI-augmented radiology education, with emphasis on the potential for "precision education" that creates personalized experiences for trainees by accounting for varying learning styles and inconsistent, possibly deficient, clinical case volume. © RSNA, 2022 Keywords: Use of AI in Education, Impact of AI on Education, Artificial Intelligence, Medical Education, Imaging Informatics, Natural Language Processing, Precision Education.

Introduction SARS-COV2 infection represents a therapeutic challenge due to the limited number of effective therapies available and due to the fact that it is not clear which host response in terms of inflammation pattern is the most predictive for an optimal (and rapid) recovery. Interferon β pathway is impaired in SARS-COV2 infection and this is associated with a bigger disease burden. Exogenous inhaled interferon might be beneficial in this setting. Areas covered Nebulized interferon-β is currently investigated as a potential therapy for SARS-COV2 because the available data from a phase II study demonstrate that this medication is able to accelerate the recovery from disease. Expert opinion Further clinical studies are needed in order to better document the efficacy of this therapy especially in severe forms of COVID-19, the optimal duration of therapy and if such a medication is appropriate for domiciliary use. Also combined regimens with antivirals or with compounds which are able to enhance the endogenous production of interferon might be of promise.

Vaccines are key in charting a path out of the COVID-19 pandemic. However, development of new vaccines is highly dependent on availability of analytical methods for their design and evaluation. This paper highlights the challenges presented in having to rapidly develop vaccine analytical tools during an ongoing pandemic, including the need to address progressive virus mutation and adaptation which can render initial assays unreliable or redundant. It also discusses the potential of new computational modeling techniques to model and analyze key viral proteins and their attributes to assist vaccine production and assay design. It then reviews the current range of analytical tools available for COVID-19 vaccine application, ranging from in vitro assays for immunogen characterization to assays to measure vaccine responses in vivo. Finally, it provides a future perspective for COVID-19 vaccine analytical tools and attempts to predict how the field might evolve over the next 5–10 years.

SARS-CoV-2, declared a pandemic in March 2020, is the current global health challenge. The global bioburden of this virus is increasing at a rapid pace. Many antiviral drugs and vaccines have been registered for clinical trials because of their inhibitory activity observed in vitro. Currently, five types of vaccines have successfully passed Phase IV clinical trial and are being administered in populations worldwide. A plethora of experimental designs have been proposed worldwide in order to find a safe and efficacious treatment option. Therefore, it is necessary to provide baseline data and information to clinicians and researchers so that they can review the current status of therapeutics and efficacy of already developed vaccines. This review article summarizes all therapeutic options that may help to combat SARS-CoV-2.

Deep learning models are currently the cornerstone of artificial intelligence in medical imaging. While progress is still being made, the generic technological core of convolutional neural networks (CNNs) has had only modest innovations over the last several years, if at all. There is thus a need for improvement. More recently, transformer networks have emerged that replace convolutions with a complex attention mechanism, and they have already matched or exceeded the performance of CNNs in many tasks. Transformers need very large amounts of training data, even more than CNNs, but obtaining well-curated labeled data is expensive and difficult. A possible solution to this issue would be transfer learning with pretraining on a self-supervised task using very large amounts of unlabeled medical data. This pretrained network could then be fine-tuned on specific medical imaging tasks with relatively modest data requirements. The authors believe that the availability of a large-scale, three-dimension–capable, and extensively pretrained transformer model would be highly beneficial to the medical imaging and research community. In this article, authors discuss the challenges and obstacles of training a very large medical imaging transformer, including data needs, biases, training tasks, network architecture, privacy concerns, and computational requirements. The obstacles are substantial but not insurmountable for resourceful collaborative teams that may include academia and information technology industry partners. © RSNA, 2022 Keywords: Computer-aided Diagnosis (CAD), Informatics, Transfer Learning, Convolutional Neural Network (CNN)

Background Patients with chronic kidney disease are underrepresented in registries and in randomized trials of coronary artery disease management. To investigate effects of chronic kidney disease on outcomes of nonemergent percutaneous coronary intervention in patients with left main or left main–equivalent coronary artery disease, we analyzed data from the New York State Percutaneous Coronary Intervention Registry during the calendar year 2015, involving 2,956 elective percutaneous coronary intervention cases. Outcomes of percutaneous coronary intervention in patients with various degrees of chronic kidney disease and stable left main or left main–equivalent coronary artery disease were compared. Methods Only patients with left main or left main–equivalent coronary artery disease and elective percutaneous coronary intervention were included in the study cohort. Patients with acute coronary syndromes within 24 hours of the index percutaneous coronary intervention, patients reported to be in shock, and patients with prior coronary artery bypass surgery were excluded from the study cohort. Results In this cohort, stage 4 or 5 chronic kidney disease, current congestive heart failure, and left main disease remained statistically significant predictors of post–percutaneous coronary intervention mortality. Conclusion Our findings in this large, statewide cohort indicate that advanced kidney disease is associated with markedly increased post–nonemergent percutaneous coronary intervention mortality.

International guidelines stipulate that autoclavation is necessary to sterilize surgical equipment. World Health Organization (WHO) guidelines for decontamination of medical devices require four levels of decontamination: cleaning, low- and high-level disinfection, as well as sterilization. Following disasters, there is a substantial need for wound care surgery. This requires prompt availability of a significant volume of instruments that are adequately decontaminated. Ideally, they should be sterilized using an autoclave, but due to the resource-limited field context, this may be impossible. The aim of this study was therefore to identify whether there are portable and less resource-demanding techniques to decontaminate surgical instruments for safe wound care surgery in disasters. A scoping review was chosen, and searches were performed in three scientific databases, grey literature, and included data from organizations and journals. Articles were scanned for decontamination techniques feasible for use in the resource-scarce disaster setting given that: they achieved at least high-level disinfected instruments, were portable, and did not require electricity. A total of 401 articles were reviewed, yielding 13 articles for inclusion. The study identified three techniques: pressure cooking, boiling, and liquid chemical immersion, all achieving either sterilized or high-level disinfected instruments. It was concluded that besides autoclaves, there are less resource-demanding decontamination techniques available for safe wound surgery in disasters. This study provides systematic information to guide optimal standard setting for sterilization of surgical material in resource-limited disaster settings.

Purpose: The principal of this analysis was to understand global feature of the number and type of grafts and number of diseased vessels of those undergoing coronary artery bypass grafting (CABG) and their short-term clinical results. Methods and Results: This report presents annual report on the collective data of CABG in the year 2018 (1 January–31 December). Data were collected based on the series of questionnaire which has been performed by The Japanese Association for Coronary Artery Surgery (JACAS), capturing the corresponding data from the Japan Adult Cardiovascular Surgery Database (JCVSD). We also analyzed descriptive clinical results of those undergoing surgeries for acute myocardial infarction and ischemic mitral regurgitation. Conclusion: This is the first article summarizing the results from annually performed questionnaires by JACAS based on JCVSD, on the trend of CABG procedures and clinical results in Japan as a scientific manuscript.

The Region of the Americas is facing accelerated demographic and epidemiological changes. As these trends will continue in future years, long-term care needs are expected to rise. How can countries respond to these challenges? We propose that countries in the Region should invest in the implementation of long-term care systems. Considering the heterogeneity in the Region, we propose a strategy based on three components: (i) understanding the problem; (ii) thinking about solutions; and (iii) building support and consensus. Depending on each country's needs and capacities, these three elements suggest short-term and long-term actions and goals, from generating better information on long-term care needs to the implementation of long-term care systems. Long-term care is a relevant issue for the Region today. The task is challenging, but countries need to embrace it and move forward before it is too late.La Región de las Américas está haciendo frente a acelerados cambios demográficos y epidemiológicos. Considerando que estas tendencias se mantendrán en los años venideros, se prevé que la necesidad de cuidados a largo plazo se incrementará. ¿Cómo pueden responder los países a estos retos?Proponemos que los países de la Región inviertan en el establecimiento de sistemas de cuidados a largo plazo. Considerando la heterogeneidad de la Región, proponemos una estrategia fundamentada en tres componentes:A Região das Américas encontra-se em transição demográfica e epidemiológica acelerada. Esta tendência deve persistir nos próximos anos e antecipa-se um crescimento da demanda por assistência a longo prazo. Como os países podem enfrentar estes desafios?A nossa proposta é que os países das Américas invistam na implementação de sistemas de assistência a longo prazo. Como a Região se caracteriza pela heterogeneidade entre os países, propomos uma estratégia alicerçada em três componentes: (i) entender o problema, (ii) buscar soluções e (iii) granjear apoio e consenso. Dependendo das necessidades e da capacidade de cada país, esses três componentes devem servir para estabelecer metas e ações a curto ou longo prazo, que vão desde aprofundar o conhecimento sobre as necessidades existentes a implementar os sistemas em si. A assistência a longo prazo é uma questão atual de interesse para a Região. A tarefa envolve muitos desafios, mas os países precisam encampá-la e avançar antes que seja tarde demais.

Granulocyte colony-stimulating factor (G-CSF)-producing tumors have an aggressive clinical course. Here, we report five cases of G-CSF-producing tumors and review the literature, focusing on imaging findings related to tumor-produced G-CSF. In addition to our cases, we identified 30 previous reports of G-CSF-producing tumors on which 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT, bone scintigraphy, or evaluation of bone marrow MR findings was performed. White blood cell count, serum C-reactive protein, and serum interleukin-6 were elevated in all cases for which these parameters were measured. G-CSF-producing tumors presented large necrotic masses (mean diameter 83.2 mm, range 17–195 mm) with marked FDG uptake (mean maximum standardized uptake value: 20.09). Diffuse FDG uptake into the bone marrow was shown in 28 of the 31 cases in which FDG-PET/CT was performed. The signal intensity of bone marrow suggested marrow reconversion in all seven MRI-assessable cases. Bone scintigraphy demonstrated no significant uptake, except in two cases with bone metastases. Splenic FDG uptake was increased in 8 of 10 cases in which it was evaluated. These imaging findings may reflect the effects of tumor-produced G-CSF. The presence of G-CSF-producing tumors should be considered in patients with cancer who show these imaging findings and marked inflammatory features of unknown origin.

To identify key indicators that will allow empirical measurement of a health system's responsiveness to older people.We conducted a series of consultations with experts to develop a relevant list of indicators. Concept mapping was used to devise the list, including the steps of preparation, brainstorming and structuring. Additionally, four countries were used as national case studies to test the feasibility of measuring health system responsiveness with readily available national-level data (Barbados, Brazil, Chile, and Mexico).Our study resulted in a list of 25 indicators scored with high usefulness for informing public policy, 10 of which were also categorized as being of high availability. National case studies were useful to assess the feasibility of measuring health system responsiveness in different settings.Responsiveness can be comprehensively assessed by (i) approaching the intrinsic features of the system via its inputs, outputs, and outcomes, and (ii) measuring the impact of the system on meeting the needs of older people in terms of their health, financial protection, and expectations. Further consensus is needed to develop a list of core indicators that could be used as a baseline for measuring a health system's responsiveness to the needs of older people.Determinar qué indicadores clave permitirán la medición empírica de la capacidad de respuesta de un sistema de salud a las personas mayores.Se llevó a cabo una serie de consultas con expertos para elaborar una lista de indicadores pertinentes. Para elaborar la lista se usó un mapeo conceptual, que incluyó los pasos de preparación, tormenta de ideas y estructuración. Además, se emplearon cuatro países en estudios de casos nacionales para evaluar la viabilidad de medir la capacidad de respuesta del sistema de salud con datos fácilmente disponibles a nivel de país (Barbados, Brasil, Chile y México).Se obtuvo una lista de 25 indicadores que se clasificaron como de alta utilidad para la fundamentación de políticas públicas, diez de los cuales también se categorizaron como de alta disponibilidad. Los estudios de casos nacionales fueron útiles para evaluar la viabilidad de medir la capacidad de respuesta del sistema de salud en diferentes entornos.La capacidad de respuesta se puede evaluar de manera integralIdentificar os principais indicadores que permitem medir de forma empírica a resposta de um sistema de saúde às pessoas idosas.Realizamos uma série de consultas com especialistas para desenvolver uma lista relevante de indicadores. O mapeamento de conceitos foi utilizado para criar a lista, incluindo as etapas de preparação, discussão de ideias e estruturação. Além disso, quatro países foram usados como estudos de casos nacionais para verificar a viabilidade de medir a capacidade de resposta do sistema de saúde com dados de nível nacional prontamente disponíveis (Barbados, Brasil, Chile e México).Nosso estudo resultou em uma lista de 25 indicadores pontuados como de grande utilidade para a informação para políticas públicas, 10 dos quais foram também classificados como de alta disponibilidade. Os estudos de casos nacionais foram úteis para avaliar a viabilidade de medir a capacidade de resposta do sistema de saúde em diferentes meios.A capacidade de resposta pode ser avaliada integralmente por meio de (i) abordagem das características intrínsecas do sistema por meio de seus insumos, resultados e desfechos, e (ii) medição do impacto do sistema na resposta às necessidades das pessoas idosas em termos de saúde, proteção financeira e expectativas. É necessário maior consenso para desenvolver uma lista de indicadores básicos que possam ser usados como linha de base para medir a capacidade de resposta de um sistema de saúde às necessidades das pessoas idosas.

This paper highlights the important leadership role of the public health sector, working with other governmental sectors and nongovernmental entities, to advance environmental public health in Latin America and the Caribbean toward the achievement of 2030 Sustainable Development Goal 3: Health and Well-Being. The most pressing current and future environmental public health threats are discussed, followed by a brief review of major historical and current international and regional efforts to address these concerns. The paper concludes with a discussion of three major components of a regional environmental public health agenda that responsible parties can undertake to make significant progress toward ensuring the health and well-being of all people throughout Latin America and the Caribbean.En este artículo se destaca el importante papel de liderazgo que tiene el sector de la salud pública, en colaboración con otros sectores gubernamentales y entidades no gubernamentales, en el fomento de la salud pública medioambiental en América Latina y el Caribe con el fin de alcanzar para el 2030 el Objetivo de Desarrollo Sostenible número 3: salud y bienestar. Se abordan las amenazas de salud pública medioambiental actuales y futuras más urgentes, y se presenta una breve revisión de las principales medidas históricas y actuales adoptadas a nivel regional e internacional para abordar estas cuestiones. El artículo finaliza con un análisis de los tres principales componentes de un programa regional de salud pública ambiental que las partes responsables pueden ejecutar para realizar progresos significativos en la garantía de la salud y el bienestar de todos en América Latina y el Caribe.Este artigo destaca o importante papel de liderança do setor de saúde pública, trabalhando com outros setores governamentais e entidades não governamentais, para promover a saúde pública ambiental na América Latina e no Caribe a fim de atingir o Objetivo de Desenvolvimento Sustentável 3 para 2030: Saúde e Bem-Estar. São discutidas as ameaças ambientais mais urgentes para a saúde pública, atuais e futuras, seguidas por uma breve revisão dos principais esforços históricos e atuais, internacionais e regionais, para abordar essas preocupações. O artigo conclui com uma discussão de três componentes essenciais de uma agenda regional de saúde pública ambiental que as partes responsáveis podem adotar para avançar significativamente no sentido de garantir a saúde e o bem-estar de todas as pessoas na América Latina e no Caribe.

The coronavirus disease 2019 (COVID‐19) pandemic has affected the care of all patients around the world. The International League Against Epilepsy (ILAE) COVID‐19 and Telemedicine Task Forces examined, through surveys to people with epilepsy (PWE), caregivers, and health care professionals, how the pandemic has affected the well‐being, care, and services for PWE. The ILAE included a link on their website whereby PWE and/or their caregivers could fill out a survey (in 11 languages) about the impact of the COVID‐19 pandemic, including access to health services and impact on mental health, including the 6‐item Kessler Psychological Distress Scale. An anonymous link was also provided whereby health care providers could report cases of new‐onset seizures or an exacerbation of seizures in the context of COVID‐19. Finally, a separate questionnaire aimed at exploring the utilization of telehealth by health care professionals since the pandemic began was available on the ILAE website and also disseminated to its members. Seventeen case reports were received; data were limited and therefore no firm conclusions could be drawn. Of 590 respondents to the well‐being survey (422 PWE, 166 caregivers), 22.8% PWE and 27.5% caregivers reported an increase in seizure frequency, with difficulty in accessing medication and health care professionals reported as barriers to care. Of all respondents, 57.1% PWE and 21.5% caregivers had severe psychological distress (k score >13), which was significantly higher among PWE than caregivers (p

As a consequence of the COVID-19 pandemic, the European Society of Cardiology (ESC) was forced to pivot the scientific programme of the ESC Congress 2021 into a totally new format for online consumption, The Digital Experience. A variety of new suppliers were involved, including experts in TV studio, cloud infrastructure, online platforms, video management, and online analytics. An information technology platform able to support hundreds of thousands simultaneous connections was built and cloud computing technologies were put in place to help scale up and down the resources needed for the high number of users at peak times. The video management system was characterized by multiple layers of security and redundancy and offered the same fluidity, albeit at a different resolution, to all user independently of the performance of their internet connection. The event, free for all users, was an undisputed success, both from a scientific/educational as well as from a digital technology perspective. The number of registrations increased by almost four-fold when compared with the 2019 record-breaking edition in Paris, with a greater proportion of younger and female participants as well as of participants from low- and middle-income countries. No major technical failures were encountered. For the first time in history, attendees from all around the globe had the same real-time access to the world’s most popular cardiovascular conference., Graphical Abstract Graphical Abstract

Robust surveillance testing is a key strategic plan to prevent COVID-19 outbreaks and slow the spread of the SARS-CoV-2 pandemic; however, limited resources, facilities and time often impair the implementation of a widespread surveillance effort. To mitigate these resource limitations, we employed a strategy of pooling samples, reducing reagent cost and processing time. Through utilizing academic faculty and labs, successful pooled surveillance testing was conducted throughout Fall 2020 semester to detect positive SARS-CoV-2 infections in a population of 4400 students. During the semester, over 25,000 individual COVID status evaluations were made by pooling eight individual samples into one quantitative reverse transcription polymerase chain reaction. This pooled surveillance strategy was highly effective at detecting infection and significantly reduced financial burden and cost by $3.6 million.

Vaccination-associated adenopathy is a frequent imaging finding after administration of COVID-19 vaccines that may lead to a diagnostic conundrum in patients with manifest or suspected cancer, in whom it may be indistinguishable from malignant nodal involvement. To help the medical community address this concern in the absence of studies and evidence-based guidelines, this paper offers recommendations developed by a multidisciplinary panel of experts from three of the leading tertiary care cancer centers in the United States. According to these recommendations, some routine imaging examinations, such as those for screening, should be scheduled before or at least 6 weeks after the final vaccination dose to allow for any reactive adenopathy to resolve. However, there should be no delay of other clinically indicated imaging (e.g., for acute symptoms, short-interval treatment monitoring, urgent treatment planning or complications) due to prior vaccination. The vaccine should be administered on the side contralateral to the primary or suspected cancer, and both doses should be administered in the same arm. Vaccination information (date(s) administered, injection site(s), laterality, and type of vaccine) should be included in every pre-imaging patient questionnaire, and this information should be made readily available to interpreting radiologists. Clear and effective communication between patients, radiologists, referring physician teams and the general public should be considered of the highest priority when managing adenopathy in the setting of COVID-19 vaccination. Summary COVID-19-vaccination–related adenopathy is a frequent imaging finding that may lead to a diagnostic conundrum in patients with manifest or suspected cancer, in whom it may be indistinguishable from malignant nodal involvement. This special report offers recommendations developed by a multidisciplinary panel of experts from three of the leading tertiary care cancer centers in the United States.

Background:A variety of infectious diseases can cause outbreaks on board vessels, with both health and economic effects. Internationally, Coronavirus Disease 2019 (COVID-19) outbreaks have occurred on numerous cruise and cargo vessels and the containment measures, travel restrictions, and border closures continue to make it increasingly difficult for ship operators world-wide to be granted pratique, effect crew changes, and conduct trade. An effective outbreak management strategy is essential to achieve the outcome triad – healthy crew, clean vessel, and set departure date – while maintaining the safety of the on-shore workers and broader community and minimizing disruption to trade. This report describes the principles of COVID-19 outbreak responses on four cargo vessels, including the successful use of one vessel as a quarantine facility.Methods:Established principles of management and the experiences of COVID-19 outbreaks on cruise ships elsewhere informed a health-lead, multi-agency, strict 14-day quarantine (Q) regime based on: population density reduction on board; crew segregation; vessel cleaning and sanitation; infection risk zones, access, and control measures; health monitoring; case identification and management; food preparation and delivery; waste management control; communication; and welfare and security.Findings:Sixty-five crew were diagnosed with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection (range 2-25; attack rate 10%-81%; 15 asymptomatic). No deaths were recorded, and only one crew was hospitalized for COVID-19-related symptoms but did not require intensive care support. Catering crew were among the cases on three vessels. All non-essential crew (n-EC) and most of the cases were disembarked. During the vessel’s Q period, no further cases were diagnosed on board, and no crew became symptomatic after completion of Q. The outbreak response duration was 15-17 days from initial decision.No serious health issues were reported, no response staff became infected, and only two Q protocol breaches occurred among crew.Interpretation:Despite increasing risk of outbreaks on cargo vessels, maritime trade and crew exchanges must continue. The potential consequences of COVID-19 outbreaks to human life and to trade necessitate a balanced response. The principles described can offer health, financial, operational, and safety advantages.

Summary Viral variants of concern may emerge with dangerous resistance to the immunity generated by the current vaccines to prevent coronavirus disease 2019 (Covid-19). Moreover, if some variants of concern have increased transmissibility or virulence, the importance of efficient public health measures and vaccination programs will increase. The global response must be both timely and science based.

Interest and incentives are increasing around strategies whereby the health care sector can better identify and address patients’ social and economic needs in the context of primary care delivery. This interest is likely to accelerate during the economic recession following the COVID-19 pandemic. Yet effective and sustainable strategies for integrating social care practices (eg, patient-facing social risk screening and activities to address identified needs) have not been clearly established. Lessons learned from more than 2 decades of research on behavioral health integration could be applied to efforts to integrate social care into primary care. In this article, we synthesize learnings from primary care and behavioral health care integration, and translate them into organizing principles with the goal of advancing social care integration practices to improve the health of both patients and communities.

The overall diagnostic yield of massively parallel sequencing–based tests in patients with chronic kidney disease (CKD) is 30% for paediatric cases and 6–30% for adult cases. These figures should encourage nephrologists to frequently use genetic testing as a diagnostic means for their patients. However, in reality, several barriers appear to hinder the implementation of massively parallel sequencing–based diagnostics in routine clinical practice. In this article we aim to support the nephrologist to overcome these barriers. After a detailed discussion of the general items that are important to genetic testing in nephrology, namely genetic testing modalities and their indications, clinical information needed for high-quality interpretation of genetic tests, the clinical benefit of genetic testing and genetic counselling, we describe each of these items more specifically for the different groups of genetic kidney diseases and for CKD of unknown origin.

Immunomodulatory and analgesic effects of dexamethasone are clinically well established, and this synthetic corticosteroid acts as an agonist of glucocorticoid receptors. Early results of the RECOVERY Trial from the United Kingdom and others suggest certain benefits of dexamethasone against COVID-19 chronic patients. The efforts have been acknowledged by World Health Organization with an interim guideline to use in patients with a severe and critical illness. The inherent genetic variations in genes such as CYP3A5, NR3C1, NR3C2, etc., involved in the pharmacokinetic and pharmacodynamic processes may influence dexamethasone’s effects as an anti-inflammatory drug. Besides, the drug may influence transcriptome or metabolic changes in the individuals. In the present review, we summarize the reported genetic variations that impact dexamethasone response and discuss dexamethasone-induced changes in transcriptome and metabolome that may influence potential treatment outcome against COVID-19., Lay abstract The surge of COVID-19 cases has increased the need for the development of a cure. This has pushed the barriers of the regulatory controls for randomized controlled trials. There has been the usage of immunomodulatory drugs, such as dexamethasone, with promising results in severe COVID-19 patients to reduce mortality. However, there is a need to consider the inherent genetic factors of an individual that may influence the dexamethasone drug’s metabolism and action. To understand this, there is a need to evaluate the genes involved in the pharmacokinetics and pharmacodynamic pathways of the drug and study the effects of the drug. This will aid in choosing the right individuals who will benefit from the therapy. Hence, the present review summarized the reported genetic variations that impact dexamethasone drug response.

This is a summary report of clinical and regulatory issues discussed at the 2018 NINDS workshop, entitled “Accelerating Therapies for Antiepileptogenesis and Disease Modification.” The intent of the workshop was to optimize and accelerate development of therapies for antiepileptogenesis (AEG) and disease modification in the epilepsies. The working group discussed nomenclature for antiepileptogenic therapies, subdividing them into “antiepileptogenic therapies” and “disease modifying therapies,” both of which are urgently needed. We use the example of traumatic brain injury to explain issues and complexities in designing a trial for disease‐preventing antiepileptogenic therapies, including identifying timing of intervention, selecting the appropriate dose, and the need for biomarkers. We discuss the recent trials of vigabatrin to prevent onset and modify epilepsy outcome in children with tuberous sclerosis (Epistop and PreVeNT). We describe a potential approach to a disease modification trial in adults, using patients with temporal lobe epilepsy. Finally, we discuss regulatory hurdles for antiepileptogenesis and disease‐modifying trials.

Several healthcare organizations across Minnesota have developed formal pharmacogenomic (PGx) clinical programs to increase drug safety and effectiveness. Healthcare professional and student education is strong and there are multiple opportunities in the state for learners to gain workforce skills and develop advanced competency in PGx. Implementation planning is occurring at several organizations and others have incorporated structured utilization of PGx into routine workflows. Laboratory-based and translational PGx research in Minnesota has driven important discoveries in several therapeutic areas. This article reviews the state of PGx activities in Minnesota including educational programs, research, national consortia involvement, technology, clinical implementation and utilization and reimbursement, and outlines the challenges and opportunities in equitable implementation of these advances.

Minimizing bias is critical to adoption and implementation of machine learning (ML) in clinical practice. Systematic mathematical biases produce consistent and reproducible differences between the observed and expected performance of ML systems, resulting in suboptimal performance. Such biases can be traced back to various phases of ML development: data handling, model development, and performance evaluation. This report presents 12 suboptimal practices during data handling of an ML study, explains how those practices can lead to biases, and describes what may be done to mitigate them. Authors employ an arbitrary and simplified framework that splits ML data handling into four steps: data collection, data investigation, data splitting, and feature engineering. Examples from the available research literature are provided. A Google Colaboratory Jupyter notebook includes code examples to demonstrate the suboptimal practices and steps to prevent them. Keywords: Data Handling, Bias, Machine Learning, Deep Learning, Convolutional Neural Network (CNN), Computer-aided Diagnosis (CAD) © RSNA, 2022

The increasing use of machine learning (ML) algorithms in clinical settings raises concerns about bias in ML models. Bias can arise at any step of ML creation, including data handling, model development, and performance evaluation. Potential biases in the ML model can be minimized by implementing these steps correctly. This report focuses on performance evaluation and discusses model fitness, as well as a set of performance evaluation toolboxes: namely, performance metrics, performance interpretation maps, and uncertainty quantification. By discussing the strengths and limitations of each toolbox, our report highlights strategies and considerations to mitigate and detect biases during performance evaluations of radiology artificial intelligence models. Keywords: Segmentation, Diagnosis, Convolutional Neural Network (CNN) © RSNA, 2022

The number of patients with primary cutaneous lymphoma (PCL) relative to other non-Hodgkin lymphomas (NHLs) is small and the number of subtypes large. Although clinical trial guidelines have been published for mycosis fungoides/Sézary syndrome, the most common type of PCL, none exist for the other PCLs. In addition, staging of the PCLs has been evolving based on new data on potential prognostic factors, diagnosis, and assessment methods of both skin and extracutaneous disease and a desire to align the latter with the Lugano guidelines for all NHLs. The International Society for Cutaneous Lymphomas (ISCL), the United States Cutaneous LymphomaConsortium (USCLC), and the Cutaneous Lymphoma Task Force of the European Organization for the Research and Treatment of Cancer (EORTC) now propose updated staging and guidelines for the study design, assessment, endpoints, and response criteria in clinical trials for all the PCLs in alignment with that of the Lugano guidelines. These recommendations provide standardized methodology that should facilitate planning and regulatory approval of new treatments for these lymphomas worldwide, encourage cooperative investigator-initiated trials, and help to assess the comparative efficacy of therapeutic agents tested across sites and studies.

Objective To inspect personal dose as an interventional radiologist for 40 years, to assess the enforcement number of interventional radiology (IR), and to check for radiation cataract. Materials and methods I evaluated my own effective dose, an equivalent dose to the lens of the eye (EDL), and the number of IR procedures between March 2019 and June 1979. I examined the lens in June 2019 as a radiologist for 40 years. Results The accumulation dose was 0 mSv in 1979–88. During 1989–93, the right crystalline lens equivalence of the value dose was measured. During 1993–96, two badge items for the head, neck, and abdomen were present. Both were distributed, but attaching to the same part and reversing occurred frequently. The EDL of the recent 5 years has exceeded 100 mSv. No association with the number of IR procedures was recognized. Posterior subcapsular vacuoles (PSV) as the early changes of the radiation cataract were recognized as four on the left and one on the right. Conclusion It is important to get accustomed to film badge wearing, and the cancelation of making a mistake in the wearing part. Radiologists should check the PSV at a stage beyond a certain constant dose.

Since the World Health Organization’s (WHO’s) pandemic declaration on March 11, 2020, coronavirus disease 2019 (COVID-19) outbreaks have occurred on numerous maritime vessels and the containment measures, travel restrictions, and border closures continue to make it increasingly difficult for ship operators world-wide to be granted pratique, conduct trade, and conduct crew changes. Knowledge of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) circulating on-board a ship prior to its arrival has significant implications for the protection of shore-based maritime workers (ie, pilots, stevedores, and surveyors), the broader community, and trade. A useful approach is a graded assessment of the public health risk. The Western Australia (WA) experience and associated observed pitfalls in implementing the prediction equation for the potential presence of SARS-CoV-2 on-board based on five COVID-19 outbreaks on commercial and cruise vessels during 2020 is described. Despite best efforts, the qualitative and quantitative predictors of SARS-CoV-2 circulating on-board commercial vessels are failing to deliver the required certainty, and to date, the only accepted method of ascertaining the presence of SARS-CoV-2 remains the real-time reverse transcription polymerase chain reaction (rRT-PCR) testing reported by an accredited laboratory. Based on legal or regulatory requirements, germane processes, underpinned by robust and auditable processes and procedures, must be put in place to inform the risk assessment of SARS-CoV-2 circulating on-board vessels.

Notum has recently been identified as a negative regulator of Wnt signaling through the removal of an essential palmitoleate group from Wnt proteins. There are emerging reports that Notum plays a role in human disease, with published data suggesting that targeting Notum could represent a new therapeutic approach for treating cancer, osteoporosis and neurodegenerative disorders. Complementary hit-finding strategies have been applied with successful approaches that include high-throughput screening, activity-based protein profiling, screening of fragment libraries and virtual screening campaigns. Structural studies are accelerating the discovery of new inhibitors of Notum. Three fit-for-purpose examples are LP-922056, ABC99 and ARUK3001185. The application of these small-molecule inhibitors is helping to further advance an understanding of the role Notum plays in human disease.

Advances in information technology have improved radiologists’ abilities to perform an increasing variety of targeted diagnostic exams. However, due to a growing demand for imaging from an aging population, the number of exams could soon exceed the number of radiologists available to read them. However, artificial intelligence has recently resounding success in several case studies involving the interpretation of radiologic exams. As such, the integration of AI with standard diagnostic imaging practices to revolutionize medical care has been proposed, with the ultimate goal being the replacement of human radiologists with AI ‘radiologists’. However, the complexity of medical tasks is often underestimated, and many proponents are oblivious to the limitations of AI algorithms. In this paper, we review the hype surrounding AI in medical imaging and the changing opinions over the years, ultimately describing AI’s shortcomings. Nonetheless, we believe that AI has the potential to assist radiologists. Therefore, we discuss ways AI can increase a radiologist’s efficiency by integrating it into the standard workflow.

Abstarct Purpose The purpose of this study is to describe the characteristic MRI, CT, and 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) findings of Wolffian tumor. Methods We reviewed preoperative images in four surgical cases of Wolffian tumor. MRI was available for review in all cases with additional diffusion-weighted images (DWI) in three, and contrast-enhanced images in two. CT was available in three. FDG-PET/CT was obtained in two. Results Two patients were asymptomatic, while the other two presented with acute abdomen. On MRI, all tumors were well-defined masses of increased signals on T2WI. Three tumors were solid, whereas the other was solid and cystic. The normal ipsilateral ovary was identified in two patients of reproductive ages, but not in two postmenopausal patients. Tumors in two patients presented with acute abdomen were complicated by hemorrhage. All three tumors evaluated on DWI showed high intensities. Contrast-enhanced images of MRI and CT showed homogeneous enhancement as the same degree as the myometrium. On CT, one tumor contained punctate calcifications. FDG-PET/CT showed moderate FDG accumulation. Conclusion Wolffian tumors may be typically solid extraovarian tumors occasionally associated with cysts and calcifications. Although they are benign, they mimic malignancy due to high intensities on DWI and increased FDG accumulation.

Objective To explore the experiences of medical laboratory professionals (MLPs) and their perceptions of the needs of clinical laboratories in response to COVID-19. Methods We surveyed laboratory professionals working in United States clinical laboratories during the initial months of the pandemic. Results Overall clinical laboratory testing and overtime work for laboratorians decreased during the first months of the pandemic. Laboratory professionals reported better or unchanged job satisfaction, feelings toward their work, and morale in their workplace, which were related to healthcare facility and laboratory leadership response. They reported receiving in-kind gifts, but no hazard pay, for their essential work. Important supply needs included reagents and personal protective equipment (PPE). Conclusion The response by healthcare facilities and laboratory leadership can influence MLPs job satisfaction, feelings toward their work, and laboratory morale during a pandemic. Current COVID-19 laboratory testing management, in the absence of sufficient reagents and supplies, cannot fully address the needs of clinical laboratories.

The COVID‐19 pandemic is raising new questions on public health competences and leadership and on health workforce preparedness for global public health emergencies. The present commentary aims to highlight demand and opportunities for innovation through the disruptions caused by the COVID‐19 crisis. We review the public health competency framework recently launched by WHO and ASPHER through the lens of COVID‐19. The framework provides guidance for aligning public health and global health competences across sectors and professional groups. Five critical competency areas can be identified in relation to public health emergencies: (1) flexibility, adaptation, motivation, communication, (2) research, analytical sensitivity, ethics, diversity, (3) epidemiology, (4) preparedness and (5) employability. However, this may not be enough. New models of public health leadership and changes in the health workforce are needed, which transform the silos of professions and policy. Such transformations would include learning, working, leading and governing differently and must stretch far beyond the public health workforce. To achieve transformative capacity, critical public health competences must be considered for all healthcare workers on all levels of policymaking, thus becoming the ‘heart’ of health workforce resilience and pandemic preparedness.

A strong public health workforce (PHW) is needed to respond to COVID‐19 and public health (PH) issues worldwide. However, classifying, enumerating, and planning the PHW is challenging. Existing PHW taxonomies and enumerations focus on the existing workforce, and largely ignore workforce competition for public health graduates (PHGs). Such efforts also do not utilize real time data to assess rapid changes to the employment landscape, like those caused by COVID‐19. A job postings analysis can inform workforce planning and educational program design alike. To identify occupations and industries currently seeking PHGs and contrast them with existing taxonomies, authors matched existing PHW taxonomies to standardized occupational classification codes, then compared this with 38,533 coded, US job postings from employers seeking Master's level PHGs from 1 July 2019 to 30 June 2020. Authors also analysed 24,516 postings from March 2019 to October 2019 and compared them with 24,845 postings from March 2020 to October 2020 to assess changing employer demands associated with COVID‐19. We also performed schema matching to align various occupational classification systems. Job postings pre‐COVID and during COVID show considerable but changing demand for PHGs in the US, with 16%–28% of postings outside existing PHW taxonomies, suggesting labour market competition which may compound PHW recruitment and retention challenges.

The COVID-19 pandemic exposed weaknesses in multiple domains and widened gender-based inequalities across the world. It also stimulated extraordinary scientific achievement, bringing vaccines to the public in under a year. In this article, we discuss the implications of current vaccination guidance for pregnant and lactating women, whether their exclusion from the first wave of vaccine trials was justified, and if a change in the current vaccine development pathway is necessary. Pregnant and lactating women were not included in initial SARS-CoV-2 vaccine trials. Perhaps unsurprisingly therefore, the first vaccine regulatory approvals have been accompanied by inconsistent advice from public health, governmental, and professional authorities around the world. Denying vaccination to women who though pregnant or breastfeeding are fully capable of autonomous decision-making is a throwback to a paternalistic era. Conversely, lack of evidence upon which to make an informed decision generated in a timely manner, shifts responsibility from research sponsors and regulators, and places the burden of decision-making upon a woman and her healthcare advisor. The World Health Organization (WHO), the Task Force on Research Specific to Pregnant Women and Lactating Women (PRGLAC), and others have highlighted the long-standing disadvantage experienced by women in relation to the development of vaccines and medicines. It is uncertain whether there was sufficient justification for excluding pregnant and lactating women from initial SARS-CoV-2 vaccine trials. In future, we recommend regulators mandate plans that describe the development pathway for new vaccines and medicines that address the needs of women who are pregnant or lactating. These should incorporate at the outset, careful consideration of the balance of risks of exclusion or inclusion from initial studies, patient and public perspectives, details of “Developmental and Reproductive Toxicity” studies, and approaches to collect data systematically from participants who are unknowingly pregnant at the time of exposure. This requires careful consideration of any prior knowledge of the mode of action of the vaccine and the likelihood of toxicity or teratogenicity. We also support the view that the default position should be a “presumption of inclusion”, with exclusion of women who are pregnant or lactating only if justified on specific, not generic, grounds. Finally, we recommend closer coordination across countries with the aim of issuing consistent public health advice.

Although statins (3-hydroxy-3-methylglutaryl-CoA reductase inhibitors) have proven effective in reducing plasma low-density lipoprotein levels and risk of cardiovascular disease, their lipid lowering efficacy is highly variable among individuals. Furthermore, statin treatment carries a small but significant risk of adverse effects, most notably myopathy and new onset diabetes. Hence, identification of biomarkers for predicting patients who would most likely benefit from statin treatment without incurring increased risk of adverse effects can have a significant public health impact. In this review, we discuss the rationale for the use of subject-derived lymphoblastoid cell lines in studies of statin pharmacogenomics and describe a variety of approaches we have employed to identify novel genetic markers associated with interindividual variation in statin response.

Epilepsy is one of the most common chronic brain diseases and is often associated with cognitive, behavioral, or other medical conditions. The need for therapies that would prevent, ameliorate, or cure epilepsy and the attendant comorbidities is a priority for both epilepsy research and public health. In 2018, the National Institute of Neurological Disease and Stroke (NINDS) convened a workshop titled “Accelerating the Development of Therapies for Antiepileptogenesis and Disease Modification” that brought together preclinical and clinical investigators and industry and regulatory bodies’ representatives to discuss and propose a roadmap to accelerate the development of antiepileptogenic (AEG) and disease‐modifying (DM) new therapies. This report provides a summary of the discussions and proposals of the Preclinical Science working group. Highlights of the progress of collaborative preclinical research projects on AEG/DM of ongoing research initiatives aiming to improve infrastructure and translation to clinical trials are presented. Opportunities and challenges of preclinical epilepsy research, vis‐à‐vis clinical research, were extensively discussed, as they pertain to modeling of specific epilepsy types across etiologies and ages, the utilization of preclinical models in AG/DM studies, and the strategies and study designs, as well as on matters pertaining to transparency, data sharing, and reporting research findings. A set of suggestions on research initiatives, infrastructure, workshops, advocacy, and opportunities for expanding the borders of epilepsy research were discussed and proposed as useful initiatives that could help create a roadmap to accelerate and optimize preclinical translational AEG/DM epilepsy research.

Emotional awareness (EA) is a key emotional process that is related to the presence and severity of chronic pain (CP). In this report, we describe primary and secondary emotions, discuss the distinction between emotional states and emotional regulation/processing, and summarize theory and research highlighting the significance of EA for CP. We describe ways to assess EA and diagnose centrally-mediated CP, for which emotional processes appear most relevant. We review several psychological interventions designed to enhance EA as well as several broader emotional processing treatments developed to address trauma and psychosocial conflicts underlying many patients’ pain. We conclude by offering our perspective on how future integration of emotional processing into pain care could promote recovery from CP.

Clinical presentations of COVID-19 exhibit a relative variation that might have roots in various circumstances. The initial infectious dose is a decisive factor in determining the fate of some viral and bacterial infections. Regarding the importance of inflammation and immunopathogenesis in the progression of COVID-19, the initial infectious dose of severe acute respiratory syndrome coronavirus 2 might have an impact on the initial inflammation and therefore the incubation period of the disease. A quick progression to severe disease might decrease the chance for successful therapy. Therefore, more release of danger-associated molecular patterns and more cytokine responses are expectable in the case of higher infectious doses. Herein we discuss the impact of initial infectious dose in the pathogenesis of similar infections such as MERS and influenza.

Severe acute respiratory syndrome coronavirus 2 has spread across the world since December 2019, infecting 100 million and killing millions. The impact on health care institutions during the coronavirus disease 2019 pandemic has been considerable, with exhaustion of institutional and personal protective equipment resources during local outbreaks and crushing financial consequences for many institutions. Establishing adaptive principles of leadership is necessary during crises, fostering quick decision-making and workflow modifications, while a rapid review of data must determine necessary course corrections. This report describes concepts of crisis leadership teams that can help maximize their effectiveness during the current and future pandemics. © RSNA, 2021

Purpose This study was conducted to investigate how the COVID‐19 pandemic has impacted reproductive medical providers’ behaviors and considerations, including their concerns regarding the necessity of fertility treatments. Methods A web‐based questionnaire was distributed to Japan Society of Fertilization and Implantation (JSFI) members from May 18 through May 31, 2020 to survey their professional behaviors and concerns during the COVID‐19 pandemic. Results Most survey participants reported a decrease in the number of patients and a decrease in their workload. Most also believe that the use of fertility treatments will return to the pre‐pandemic levels after the COVID‐19 pandemic ends. Additionally, more than half of the participants reported that they consider fertility treatment neither necessary nor unnecessary during the COVID‐19 pandemic. Conclusions At the institute where reproductive medical providers worked in Japan, the number of outpatients and the working time tended to decrease during the COVID‐19 pandemic. However, amid fears of infection during the COVID‐19 pandemic, the reproductive medical providers working at fertility institutes in Japan have remained engaged in their work with a sense of mission and hope.