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BACKGROUND. Imaging biomarkers of response to neoadjuvant therapy (NAT) for pancreatic ductal adenocarcinoma (PDA) are needed to optimize treatment decisions and long-term outcomes. OBJECTIVE. The purpose of this study was to investigate metrics from PET/MRI and CT to assess pathologic response of PDA to NAT and to predict overall survival (OS). METHODS. This retrospective study included 44 patients with 18F-FDG-avid borderline resectable or locally advanced PDA on pretreatment PET/MRI who also underwent post-NAT PET/MRI before surgery between August 2016 and February 2019. Carbohydrate antigen 19-9 (CA 19-9) level, metabolic metrics from PET/MRI, and morphologic metrics from CT (n = 34) were compared between pathologic responders (College of American Pathologists scores 0 and 1) and nonresponders (scores 2 and 3). AUCs were measured for metrics significantly associated with pathologic response. Relation to OS was evaluated with Cox proportional hazards models. RESULTS. Among 44 patients (22 men, 22 women; mean age, 62 ± 11.6 years), 19 (43%) were responders, and 25 (57%) were nonresponders. Median OS was 24 months (range, 6-42 months). Before treatment, responders and nonresponders did not differ in CA 19-9 level, metabolic metrics, or CT metrics (p > .05). After treatment, responders and nonresponders differed in complete metabolic response (CMR) (responders, 89% [17/19]; nonresponders, 40% [10/25]; p = .04], mean change in SUVmax (ΔSUVmax; responders, -70% ± 13%; nonresponders, -37% ± 42%; p < .001), mean change in SUVmax corrected to serum glucose level (ΔSUVgluc) (responders, -74% ± 12%; nonresponders, -30% ± 58%; p < .001), RECIST response on CT (responders, 93% [13/14]; nonresponders, 50% [10/20]; p = .02)], and mean change in tumor volume on CT (ΔTvol) (responders, -85% ± 21%; nonresponders, 57% ± 400%; p < .001). The AUC of CMR for pathologic response was 0.75; ΔSUVmax, 0.83; ΔSUVgluc, 0.87; RECIST, 0.71; and ΔTvol 0.86. The AUCs of bivariable PET/MRI and CT models were 0.83 (CMR and ΔSUVmax), 0.87 (CMR and ΔSUVgluc), and 0.87 (RECIST and ΔTvol). OS was associated with CMR (p = .03), ΔSUVmax (p = .003), ΔSUVgluc (p = .003), and RECIST (p = .046). CONCLUSION. Unlike CA 19-9 level, changes in metabolic metrics from PET/MRI and morphologic metrics from CT after NAT were associated with pathologic response and OS in patients with PDA, warranting prospective validation. CLINICAL IMPACT. Imaging metrics associated with pathologic response and OS in PDA could help guide clinical management and outcomes for patients with PDA who undergo emergency therapeutic interventions.

Please see the Editorial Comment by Ellen B. Mendelson discussing this article. BACKGROUND. The literature has reported varying rates of malignancy for architectural distortion (AD) on digital brea...

BACKGROUND: There is a wide variation in radiation dose levels that can be used with chest CT in order to detect indeterminate pulmonary nodules. PURPOSE: To compare the performance of lower-radiation-dose chest CT with that of routine dose in the detection of indeterminate pulmonary nodules 5 mm or greater. MATERIALS AND METHODS: In this retrospective study, CT projection data from 83 routine-dose chest CT examinations performed in 83 patients (120 kV, 70 quality reference mAs [QRM]) were collected between November 2013 and April 2014. Reference indeterminate pulmonary nodules were identified by two nonreader thoracic radiologists. By using validated noise insertion, five lower-dose data sets were reconstructed with filtered back projection (FBP) or iterative reconstruction (IR; 30 QRM with FBP, 10 QRM with IR, 5 QRM with FBP, 5 QRM with IR, and 2.5 QRM with IR). Three thoracic radiologists circled pulmonary nodules, rating confidence that the nodule was a 5-mm-or-greater indeterminate pulmonary nodule, and graded image quality. Analysis was performed on a per-nodule basis by using jackknife alternative free-response receiver operating characteristic figure of merit (FOM) and noninferiority limit of −0.10. RESULTS: There were 66 indeterminate pulmonary nodules (mean size, 8.6 mm ± 3.4 [standard deviation]; 21 part-solid nodules) in 42 patients (mean age, 51 years ± 17; 21 men and 21 women). Compared with the FOM for routine-dose CT (size-specific dose estimate, 6.5 mGy ± 1.8; FOM, 0.86 [95% confidence interval: 0.80, 0.91]), FOM was noninferior for all lower-dose configurations except for 2.5 QRM with IR. The sensitivity for subsolid nodules at 70 QRM was 60% (range, 48%–72%) and was significantly worse at a dose of 5 QRM and lower, whether or not IR was used (P < .05). Diagnostic image quality decreased with decreasing dose (P < .001) and was better with IR at 5 QRM (P < .05). CONCLUSION: CT images reconstructed at dose levels down to 10 quality reference mAs (size-specific dose estimate, 0.9 mGy) had noninferior performance compared with routine dose in depicting pulmonary nodules. Iterative reconstruction improved subjective image quality but not performance at low dose levels.

The flexed elbow, abducted shoulder, forearm supinated (FABS) position has been described as a method of imaging the distal biceps tendon on its long axis. The purpose of this study is to evaluate whether obtaining additional MR imaging in the FABS position changes the radiologist’s assessment of the distal biceps tendon compared with traditional sequences only. Blinded review of 46 elbow MRIs when viewed without (−F) and with (+F) FABS sequences available was performed by two independent readers. The biceps tendon was graded in each case using a 0–3 scale, and a confidence level of 0–10 was assigned. −F and +F reads were compared. Reads were also compared with the surgical reference standard when available, 12 patients. Pooled intra rater reliability was 0.800 (0.714, 0.886) between the −F and +F groups. Pooled mean confidence was 7.163 (1.252) for the −F group and 8.370 (1.264) for the +F group (p < 0.001). Pooled diagnostic accuracy was 0.651 (0.420, 0.882) for the −F group and 0.615 (0.456, 0.875) for the +F group compared with the surgical reference standard. The FABS sequence changed the radiologist’s impression of the distal biceps tendon in the minority of cases and did not significantly change diagnostic accuracy. We do not recommend its use in the majority of cases. In challenging cases of high-grade partial vs complete tendon tear, FABS may be helpful to identify subtle residual tendon fibers.

Background Low tube potential-high tube current computed tomography (CT) imaging allows reduction in iodine-based contrast dose and may extend the benefit of routine contrast-enhanced CT exams to patients at risk of nephrotoxicity. Purpose To determine the ability of an iodine contrast reduction algorithm to maintain diagnostic image quality for contrast-enhanced abdominal CT. Material and Methods CT exams with iodine contrast reduction were prescribed for patients at risk for renal dysfunction. The iodine contrast reduction algorithm combines weight-based contrast volume reduction with patient width-based low tube potential selection and bolus-tracking. Control exams with routine iodine dose were selected based on weight, width, and scan protocol. Three radiologists evaluated image quality and diagnostic confidence using a 4-point scale (Results Forty-six contrast reduction algorithm and control exams were compared (mean creatinine 1.6 vs. 1.2 mg/dL, P ≤ 0.0001). Thirty-nine contrast reduction patients had an eGFR 2 and 15 had single or transplanted kidney. Mean iodine contrast dose was lower in the contrast reduction group (20.9 vs. 39.4 g/mL, P < 0.0001). Diagnostic confidence was rated as acceptable in 95% (131/138) of contrast reduction and 100% of control exams (1.18–1.28 vs. 1.02–1.13, respectively; P > 0.06). Liver attenuation and contrast-to-noise ratio (CNR) were similar ( P = 0.08), but portal vein attenuation and CNR were lower with contrast-reduction (mean 176 vs. 198 HU, P = 0.02; 13 vs. 16, P = 0.0002). Conclusion This size-based contrast reduction algorithm using low kV and bolus tracking reduced iodine contrast dose by 50%, while achieving acceptable image quality in 95% of exams.

To determine how small bowel neuroendocrine neoplasms (SBNEN’s) are diagnosed and examine the effect of CT enterography (CTE) on diagnosis and rates of disease-free survival. Histopathologically-confirmed SBNEN’s diagnosed at our institution between 1996 and 2016 were identified. Clinical presentation, radiology, endoscopy, surgery, and pathology reports were reviewed and compared between consecutive 5-year periods. Of the 178 SBNEN initially diagnosed at our institution, the incidence increased 12-fold from 9 (during 1996–2000) to 114 (during 2011–2016). Comparing the first 5 to the last 5 years, GI bleeding and abdominal pain increased significantly as indications (with both increasing from 0 to > 25%, p ≤ 0.023). Initial diagnosis by radiology increased 2-fold [from 33% (n = 3) to 66% (n = 75); p = 0.263]. Detection of a small bowel mass and the suggestion that SBNEN was present varied significantly between imaging modalities (p

The UK Conservative Government 2017-2019 has taken steps to promote Engagement as a means of Knowledge Exchange (KE). In 2019/2020, a Knowledge Exchange Framework (KEF) will be introduced alongside the existing Research (REF) and Teaching (TEF) evaluations. Indeed, the OfS (Office for Students) and UKRI (UK Research and Innovation) [2018. Collaboration Agreement between the Office for Students (OfS) and UK Research and Innovation. London: OfS, 1] regard each of these evaluations as 'mutually reinforcing'. Given that the KEF is likely to take place in full for the first time in 2020, it is essential that colleagues understand both the nature of the Engagement agenda, the reasons for its emergence, the possibilities it offers and means by which to reduce opportunity cost. In this article, I draw upon a range of resources to present a clear overview of these factors and argue that KEF can be harnessed effectively for a number of, often socially valuable, ends and that its most onerous implications can be mitigated efficiently.

Background Dual-energy virtual monoenergetic images can increase iodine signal, potentially increasing the conspicuity of hepatic masses. Purpose To determine if dual-energy 50-keV virtual monoenergetic images improve visualization of key imaging findings or diagnostic confidence for small (≤2 cm) hepatocellular carcinomas (HCC) at multiphase, contrast-enhanced liver computed tomography (CT). Material and Methods Patients with chronic liver disease underwent multiphase dual-energy CT imaging for HCC, with late arterial and delayed phase dual-energy 50-keV images reconstructed. Two non-reader subspecialized gastrointestinal (GI) radiologists established the reference standard, determining the location and diagnosis of all hepatic lesions using predetermined criteria. Three GI radiologists interpreted mixed kV CT images without or with dual-energy 50-keV images. Radiologists identified potential HCCs and rated their confidence (0–100 scales) in imaging findings of arterial enhancement, enhancing capsule, tumor washout, and LI-RADS 5 (2018) category. Results In total, 45 patients (14 women; mean age = 59.5 ± 10.9 years) with chronic liver disease were included. Of them, 19 patients had 25 HCCs ≤2 cm (mean size = 1.5 ± 0.4 cm). There were 17 LI-RADS 3 and 4 lesions and 19 benign lesions. Reader confidence in imaging findings of arterial enhancement, enhancing capsule, and non-peripheral washout significantly increased with dual-energy images ( P ≤ 0.022). Overall confidence in HCC diagnosis increased significantly with dual-energy 50-keV images (52.4 vs. 68.8; P = 0.001). Dual-energy images demonstrated a slight but significant decrease in overall image quality. Conclusion Radiologist confidence in key imaging features of small HCCs and confidence in imaging diagnosis increases with use of dual-energy 50-keV images at multiphase, contrast-enhanced liver CT.

Background: Sleep disorders are associated with having or developing type 2 diabetes, increased insulin resistance, and higher BMI. The relationship between sleep duration and continuous glucose monitoring (CGM) metrics has not been well studied. We examined the relationship between CGM-based metrics and sleep duration in a population without diabetes. Methods: Glucose metrics from a 10-day blinded CGM (Dexcom G6) wear and sleep metrics from a concurrent unblinded Fitbit wear were collected. Participants (mean (SD) age= 49.1 (10) years, BMI= 29.5 (8) kg/m2, 90% female, 14% African American) were recruited from an employee health plan in the Southeastern US. Forty-nine individuals without diabetes or prediabetes were included in this analysis. A linear regression model adjusting for age and BMI was used to evaluate the relationship between mean daytime glucose and nightly hours of sleep. Results: Participants recorded a median (IQR) 6.4 (6.1, 7.1) nightly hours of sleep, 6416 (5112, 8071) daily steps, and 12.7 (12.1, 13.5) daily sedentary hours. Mean (SD) mean daytime glucose was 112.7 (11.5) mg/dL and coefficient of variation was 15.4 (3) %. Mean daytime glucose was significantly and inversely associated with nightly hours of sleep (Beta= -3.1, p Conclusion: In this population without diabetes, each additional one hour of sleep was associated with 3.1 mg/dL lower mean daytime glucose. This finding aligns with existing research on the protective effects of sleep on glycemic health and suggests it may be beneficial for people at risk for developing diabetes to improve their sleep habits. Longitudinal research where behavioral data is collected along with CGM can provide further insights into correlates of developing prediabetes and type 2 diabetes. Disclosure M. A. Crawford: Employee; Self; Dexcom, Inc. S. K. Pickus: Employee; Self; Dexcom, Inc. K. C. Hames: Employee; Self; Dexcom, Inc. M. Johnson: Employee; Self; Dexcom, Inc. I. J. Klein: None. G. J. Norman: Employee; Self; Dexcom, Inc.

Recent studies suggest COVID-19 infection has a detrimental effect on glycemic control in patients with diabetes in the acute care setting. However, there is limited information about the impact of COVID-19 on glycemic control in the months following infection. In this retrospective observational study, we examined the correlation between COVID-19 infection and glycemic control in adult patients with elevated A1c in a single health system (n=3,295). Patients were selected from a cohort of those age 18 years or older who were tested for COVID-19 between 3/1/2020 and 11/1/2020. COVID positive patients were identified through positive SARS-CoV-2 PCR or a COVID flag in the EMR. COVID negative patients were randomly selected in a 3:1 ratio from all patients who had a negative COVID test in the same week as each positive patient. Patients from this cohort were included if they had a baseline A1c ≥ 5.7% measured in the preceding six months and at least two weeks prior to their COVID positive (n=670) or COVID negative (n=2,625) test date, as well as an endpoint A1c ≥ 5.7% at least three months after this date. The study population was 54% female, 60% White, 20% Hispanic, and 13% Black with a mean BMI 32 ± 7.3 kg/m2, age 64.1 ± 13.6 yrs, and baseline A1c of 7.7± 1.6 %; 81% of patients had a diagnosis of type 2 diabetes. In a linear regression model, COVID-19 infection was significantly associated with increased endpoint A1c (coefficient = 0.14, 95% CI [0.03 - 0.25], p = 0.01). Baseline A1c, male sex, and Hispanic ethnicity were also significantly associated with increased A1c, while age and median income based on zip code were associated with decreased A1c. In conclusion, prior COVID-19 infection appears to be associated with worse glycemic control at least 3 months post-infection compared to patients who did not contract COVID-19. Additional research is needed to determine if this association is present in other patient populations as well as the physiologic and socio-demographic causes for this finding. Disclosure E. G. Thurber: None. M. E. Mcdonnell: Stock/Shareholder; Spouse/Partner; Abbott Diabetes. G. Cromwell: None. M. Johnson: None. D. C. Simonson: Stock/Shareholder; Spouse/Partner; Phase V Technologies, Inc. N. E. Palermo: None.

Background Carotid-cavernous fistulas (CCFs) are commonly misdiagnosed on computed tomography angiography (CTA). Purpose This study sought to identify the most sensitive and specific imaging features of CCFs on CTA. Material and Methods A retrospective review identified 18 consecutive patients suspected of having a CCF on CTA and subsequently underwent digital subtraction angiography (DSA). Two blinded reviewers assessed multiple findings on CTA: cavernous sinus asymmetry/enlargement; arterial-phase contrast in the cavernous sinus; proptosis; pre- or post-septal orbital edema; and dilated regional vasculature. Each was graded as positive, possible, and negative; “possible” was counted as positive. A third blinded reviewer served as a tiebreaker. Results Of 18 patients, nine were true-positive and nine were false-positive. Superior ophthalmic vein early enhancement and dilatation had 100.0% sensitivity (95% confidence interval [CI] 40.0–100.0) and 77.8% specificity (95% CI 44.4–100.0); arterial-phase contrast in the cavernous sinus had 88.9% sensitivity (95% CI 44.4–100.0) and 66.7% specificity (95% CI 18.5–90.1); peri-orbital edema had 88.9% sensitivity (95% CI 35.5–100.0) and 77.8% specificity (95% CI 22.2–100.0). The most specific markers of CCF were superior petrosal sinus and inferior ophthalmic vein dilatation/enhancement (100.0%, 95% CI 88.8–100.0 and 88.9%, 95% CI 44.4–100.0, respectively); the specificity of asymmetric cavernous enlargement was 44.4% (95% CI 11.1–77.7). Conclusions Among patients in whom a CCF is suspected on CTA, superior ophthalmic vein dilatation/enhancement and arterial-phase contrast within the cavernous sinus are the most sensitive findings. Asymmetric cavernous sinus enlargement has poor specificity and may result in false-positive diagnoses of CCFs. False positive cases were less likely to have an optimally timed contrast bolus.

ObjectiveWe evaluated the accuracy of molecular breast imaging (MBI)—a nuclear medicine technique that employs dedicated dual-detector, cadmium zinc telluride gamma cameras to image the functional uptake of a radiopharmaceutical (typically Tc-99m sestamibi) in the breast—in patients with suspicious calcifications on mammography.MethodsWomen scheduled for stereotactic biopsy of calcifications detected on 2D digital mammography were prospectively enrolled to undergo MBI before biopsy. Molecular breast imaging was performed with injection of Tc-99m sestamibi and a dual-detector, cadmium zinc telluride gamma camera. Positive findings on either modality were biopsied. High-risk and malignant biopsy findings were excised.ResultsIn 71 participants, 76 areas of calcifications were recommended for biopsy after mammography, and 24 (32%) were malignant, including 20 cases of ductal carcinoma in situ (DCIS) and 4 cases of invasive ductal cancer. Prebiopsy MBI was positive in 17 of the 76 (22%) calcifications, including 10 of 20 (50%) DCISs and 2 of 4 (50%) invasive cancers. The median pathologic size for MBI–positive cancers was 1.5 cm (range 0.5–3.2 cm) compared with 0.9 cm (range 0.1–2.0 cm) for MBI–negative cancers (P = 0.09).Non-mass uptake on MBI led to additional biopsies of 6 sites in 6 patients, and 2 of 6 (33%) MBI–detected incidental lesions showed malignancy; both DCIS contralateral to the mammographically detected calcifications. The overall per-lesion positive and negative predictive values of MBI in this prebiopsy setting were 61% (14 of 23) and 80% (47 of 59), respectively.ConclusionMolecular breast imaging has insufficient negative predictive value to identify calcifications in which biopsy could be avoided. However, among women presenting for biopsy of suspicious calcifications, MBI revealed additional sites of mammographically occult breast cancer.To avoid biopsy of suspicious calcifications on mammography, negative findings on MBI should not be used.

OBJECTIVES: The study sought to define the risk of stent thrombosis (ST) and myocardial infarction (MI) in cancer patients compared with noncancer patients after percutaneous coronary intervention (PCI). BACKGROUND: Cancer patients are considered to be at high thrombotic risk, but data on whether this is the case after PCI remain inconclusive. METHODS: Cancer patients undergoing PCI at Mayo Clinic Rochester from January 1, 2003, to December 31, 2013, were identified by cross-linking institutional cancer and PCI databases and by propensity score matching to noncancer patients. The combined primary endpoint was all-cause mortality, MI, and revascularization rate at 5-year follow-up. Secondary endpoints were the individual primary endpoint components, cause of mortality, ST, and Bleeding Academic Research Consortium 2+ bleeding. RESULTS: The primary endpoint occurred in 48.6% of 416 cancer and in 33.0% of 768 noncancer patients (p < 0.001). In competing risk analyses, cancer patients had a higher rate of noncardiac death (24.0% vs. 10.5%; p < 0.001) and a lower rate of cardiac death (5.0% vs. 11.7%; p < 0.001). Cancer patients had a higher rate of MI (16.1% vs. 8.0%; p < 0.001), ST (6.0% vs. 2.3%; p < 0.001), repeat revascularization (21.2% vs. 10.0%; p < 0.001), and bleeding (6.7% vs. 3.9%; p = 0.03). The most critical period for ST in cancer patients was in the first year after PCI. The dual antiplatelet therapy score was predictive of thrombotic and ischemic events in both groups. CONCLUSIONS: Cancer patients have a higher risk of thrombotic and ischemic events after PCI, identifiable by a high dual antiplatelet therapy score. These findings have important implications for antiplatelet therapy decisions.

Incorporating CGM into worksite health screenings may help employees gain insight into their glycemic patterns. This observational study piloted a voluntary health screening at a large employer that included 10 days of blinded Dexcom G6 CGM wear. At enrollment, HbA1c values and participants’ reports were used to assign diabetes status. Participants and their primary care providers received summaries of their CGM-based glucose profiles. A total of 207 participants (mean (sd) age = 50.7 (10), 84% female, 15% African American, 15% Hispanic, 56% obese) enrolled in the screening from April through August 2019, and 85% (175) wore the CGM for ≥4 days. HbA1c identified 7 and 24 participants with previously undiagnosed T2D and prediabetes, respectively. The final diabetes prevalence was 61 (35%) with T2D, 5 (3%) with T1D, 35 (20%) with prediabetes, and 74 (42%) with no diabetes. Among those with T2D, 27 (44%) met consensus-based goals for TIR. The Table shows CGM-based metrics from health screening participants compared to Shah’s (2019) normative sensor glucose data of people without diabetes. Those with prediabetes had higher mean glucose and lower TIR than the normative sample. Health screenings that include blinded CGM provide personalized feedback regarding glycemic patterns, even among people without known diabetes. Disclosure I.J. Klein: Consultant; Self; Dexcom, Inc. M. Crawford: Employee; Self; Dexcom, Inc. G.J. Norman: Employee; Self; Dexcom, Inc. K.C. Hames: Employee; Self; Dexcom, Inc. J.I. Justus: None. S. Treadwell: Employee; Self; Dexcom, Inc. T.M. Combee: None. S. Kinzler: Research Support; Self; Dexcom, Inc. J. Welsh: Employee; Self; CSL Behring. M. Johnson: Employee; Self; Dexcom, Inc.

Limited data are available on characteristics and long-term outcomes of patients with coronary artery bypass grafts (CABG) undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI). Between January 2000 to December 2014, we identified STEMI patients with prior CABG undergoing primary percutaneous coronary intervention from 3 sites. Kaplan-Meier methods to estimate survival and major adverse cardiac events (MACE) were employed and compared to a propensity matched cohort of non-CABG STEMI patients. Independent predictors of outcomes were analyzed with Cox modeling. Of the 3,212 STEMI patients identified, there were 296 (9.2%) CABG STEMI patients, having nearly similar frequencies of culprit graft (47.6%) versus culprit native (52.4%) as the infarct-related artery (IRA). At 10 years, the adjusted survival was 44% in CABG STEMI versus 55% in non-CABG STEMI (HR 1.26; 95%CI 0.86 to 1.87; p = 0.72). Survival free of MACE was lower for CABG STEMI (graft IRA, 37%; native IRA, 46%) as compared to non-CABG STEMI controls (63%) (p = 0.02). Neither CABG history nor IRA (native vs graft) was independently associated with death or MACE in multivariable analysis. Temporal trends showed no significant change in death or MACE rates of CABG STEMI patients over time. In conclusion, long term survival of CABG STEMI patients is not significantly different than matched STEMI patients without prior CABG; however, CABG STEMI patients were at significantly higher risk for MACE events.

Background Mental health after spontaneous coronary artery dissection ( SCAD ), a cause of myocardial infarction in young women, remains largely unexplored. We assessed the prevalence and severity of psychiatric symptoms after SCAD . Methods and Results Individuals with confirmed SCAD who consented to the Mayo Clinic “Virtual” Multicenter SCAD Registry were sent the Posttraumatic Stress Disorder Diagnostic Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition , Patient Health Questionnaire‐9, Generalized Anxiety Disorder‐7, Anxiety Sensitivity Index, Connor‐Davidson Resilience Scale, 36‐Item Short‐Form Health Survey, and an SCAD ‐specific questionnaire. Among 782 patients contacted, 512 surveys were returned. Most respondents were women (97.5%), with median age at time of SCAD and survey completion of 47 and 52 years, respectively. Eighty‐two percent had at least one trauma, with mild or more posttraumatic stress disorder symptoms in 28%. Symptoms of anxiety and depression were observed in 41% and 32%, respectively. On multivariable analysis, those of younger age at first SCAD and low resiliency scored higher on measures of trauma, anxiety, and depression. Those with higher anxiety sensitivity had more severe anxiety and posttraumatic stress disorder symptoms. Emotional and social quality of life was higher in those with high resiliency scores. Time from SCAD event to survey completion was associated with lower Generalized Anxiety Disorder‐7 score severity. Conclusions Survivors of SCAD have significant rates of posttraumatic stress disorder, depression, and anxiety, which are associated with lower quality of life specifically among those with lower resiliency. Given the prevalence and potential impact, screening and treatment for the psychological distress is advised. Behavioral interventions targeted toward resiliency training may be beneficial for this patient population.

ObjectiveSymptoms and clinical course during inflammatory bowel disease (IBD) vary among individuals. Personalised care is therefore essential to effective management, delivered by a strong patient-centred multidisciplinary team, working within a well-designed service. This study aimed to fully rewrite the UK Standards for the healthcare of adults and children with IBD, and to develop an IBD Service Benchmarking Tool to support current and future personalised care models.DesignLed by IBD UK, a national multidisciplinary alliance of patients and nominated representatives from all major stakeholders in IBD care, Standards requirements were defined by survey data collated from 689 patients and 151 healthcare professionals. Standards were drafted and refined over three rounds of modified electronic-Delphi.ResultsConsensus was achieved for 59 Standards covering seven clinical domains; (1) design and delivery of the multidisciplinary IBD service; (2) prediagnostic referral pathways, protocols and timeframes; (3) holistic care of the newly diagnosed patient; (4) flare management to support patient empowerment, self-management and access to specialists where required; (5) surgery including appropriate expertise, preoperative information, psychological support and postoperative care; (6) inpatient medical care delivery (7) and ongoing long-term care in the outpatient department and primary care setting including shared care. Using these patient-centred Standards and informed by the IBD Quality Improvement Project (IBDQIP), this paper presents a national benchmarking framework.ConclusionsThe Standards and Benchmarking Tool provide a framework for healthcare providers and patients to rate the quality of their service. This will recognise excellent care, and promote quality improvement, audit and service development in IBD.

In England and Wales, the introduction of £9,250 Higher Education tuition fees and concern more broadly about social mobility has led to the creation of a series of initiatives aimed at Widening Participation. Increasingly, critics argue that these initiatives have failed to achieve genuine representativeness, with lower ranked universities absorbing higher numbers of students from under-represented groups, who then face additional challenges in securing progression to employment. In this article, we examine dominant narratives Widening Participation programmes in England and Wales in order to assert means of widening more effectively access, in the first instance, but also retention and progression. Rejecting non-subject-specific instrumental approaches that focus directly on graduate labour market value and earnings, we argue that effective Widening Participation ought to focus centrally on the institutional value of Higher Education and on fostering social capital, especially in lower ranked universities whose graduates are already discriminated against in the labour market. To this end, we evaluate deployment of a Politics-based Widening Participation programme, Rethinking Disadvantage, asserting a set of conclusions for colleagues in other disciplines and institutions seeking to develop their own approaches.

BACKGROUND Inflammatory bowel disease (IBD) patients are at risk of developing complications from metabolic bone disease, but the exact prevalence is unknown. We evaluated fracture risk in IBD patients using (1) biomechanical CT analysis (BCT) using bone strength and bone mineral density (BMD), (2) Cornerstone guidelines, and (3) other clinical features predicting fracture risk. METHODS A retrospective review of consecutive IBD patients who underwent CT enterography (CTE) with BCT from March 2014 to March 2017 was performed. Measured outcomes were overall fracture risk classification (not increased, increased, or high) and femoral neck BMD World Health Organization classification (normal, osteopenia, or osteoporosis). RESULTS Two hundred fifty-seven patients with IBD underwent CTE and BCT. Fracture risk was classified as not increased in 45.5% (116/255) of patients, increased in 44.7% (114/255), and high in 9.8% (25/255). Femoral neck BMD was classified as normal in 56.8% (142/250), osteopenia in 37.6% (94/250), and osteoporosis in 5.6% (14/250). In multivariate analysis, only increasing age was associated with increased fracture risk (odds ratio, 1.06; 95% confidence interval, 1.04-1.08; P < 0.001). Cornerstone guidelines were met by 35.3% (41/116), 56.1% (64/114), and 76.0% (19/25) of patients in the not increased, increased, and high-risk groups, respectively (P = 0.0001). No Cornerstone criteria were met by 40% (56/139) of patients in the increased and high-risk groups. CONCLUSIONS Using BCT, increased or high fracture risk was detected in more than half of this cohort, the prevalence being associated with increased age. A significant proportion of patients with increased or high fracture risk did not meet Cornerstone guidelines. Therefore, IBD patients who do not meet Cornerstone guidelines may benefit from BCT screening.

Purpose To determine if the use of heat-based track ablation with new-generation cryoprobes is associated with decreased renal cryoablation bleeding complications. Materials and Methods Eighty-nine patients who underwent percutaneous cryoablation for treatment of a solitary renal mass with the use of cryoprobes with track ablation (CwTA) from October 29, 2015, to May 18, 2017, were compared with a propensity score–matched control group of 178 patients who underwent treatment with the use of cryoprobes without track ablation (Cw/oTA) from January 5, 2012, to October 28, 2015. Bleeding complications were assessed with the use of the Clavien-Dindo classification system and compared between the matched patient groups by means of conditional logistic regression, both univariately and in a multivariate model to adjust for imbalanced covariates. Change in patient hemoglobin was evaluated as a secondary measure of periprocedural bleeding. Results Seven of the 89 patients (7.9%) who underwent percutaneous renal cryoablation with the use of CwTA developed major (grade ≥3) bleeding complications, versus 13 of the 178 patients (7.3%) treated with the use of Cw/oTA. Conditional logistic regression analysis adjusted for potential confounders showed that major, minor, and overall bleeding complications were not associated with the type of cryoprobes used for treatment ( P values .727, .370, and .733, respectively). There was also no significant difference in postprocedural change in hemoglobin for patients treated with the use of CwTA compared with Cw/oTA ( P = .909). Furthermore, total duration of track ablation in patients with bleeding complications (mean 169 seconds, SD 68, range 60–240) was not significantly different than in patients without bleeding complications (mean 171 seconds, SD 86, range 30–360; P = .940). Conclusions The use of cryoprobes with heat-based track ablation did not decrease the incidence of bleeding complications after renal cryoablation compared with procedures performed without track ablation.

Purpose To determine which nocturnal blood pressure (BP) parameters (low levels or extreme dipper status) are associated with an increased risk of glaucomatous damage in Hispanics. Design Observational cross-sectional study. Participants A subset (n = 93) of the participants from the Maracaibo Aging Study (MAS) who met the study eligibility criteria were included. These participants, who were at least 40 years of age, had measurements for optical tomography coherence, visual field (VF) tests, 24-hour BP, office BP, and intraocular pressure Methods Univariate and multivariate logistic regression analyses under the generalized estimating equations (GEE) framework were used to examine the relationships between glaucomatous damage and BP parameters, with particular attention to decreases in nocturnal BP. Main Outcome Measures Glaucomatous optic neuropathy (GON) based on the presence of optic nerve damage and VF defects. Results The mean age was 61.9 years, and 87.1% were women. Of 185 eyes evaluated, 19 (26.5%) had signs of GON. Individuals with GON had significantly lower 24-hour and nighttime diastolic BP levels than those without. However, results of the multivariate GEE models indicated that the glaucomatous damage was not related to the average systolic or diastolic BP levels measured over 24 hours, daytime, or nighttime. In contrast, extreme decreases in nighttime systolic and diastolic BP (>20% compared with daytime BP) were significant risk factors for glaucomatous damage (odds ratio, 19.78 and 5.55, respectively). Conclusions In this population, the link between nocturnal BP and GON is determined by extreme dipping effects rather than low nocturnal BP levels alone. Further studies considering extreme decreases in nocturnal BP in individuals at high risk of glaucoma are warranted.

This paper provides a summary of the status of the design process for a low-enrichment replacement for the high-enrichment fuel that has historically been used in the Advanced Test Reactor (ATR) at Idaho National Laboratory. Under current long-term Department of Energy policy, the ATR will be converted to operate using low-enrichment fuel by 2030. To this end, an engineering evaluation and design process has been underway for more than ten years. Initially performed as a series of scoping studies for different design options, the last five years have seen a transition to a formal Safety-in-Design approach to the design and safety evaluation process. This paper focuses on such efforts in progress since 2012 to identify pre-conceptual and conceptual design candidates for ATR conversion. The Enhanced LEU Fuel (ELF) design is selected as the most promising conceptual design. Analyses and trade-off studies performed that led to that selection are described. Finally, analysis of certain aspects of core performance for an ELF-fueled core relative to the current high-enrichment fuel show that only small and manageable changes to core operations will be necessary to support conversion of ATR to low-enrichment fuel.

PURPOSE: To identify whether long-term symptom relief and stent patency vary with the use of covered versus uncovered stents for the treatment of benign SVC obstruction. METHODS AND MATERIALS: We retrospectively identified all patients with benign SVC syndrome treated to stent placement between January 2003 and December 2015 (n = 59). Only cases with both clinical and imaging follow-up were included (n = 47). In 33 (70%) of the patients, the obstruction was due to a central line or pacemaker wires, and in 14 (30%), the cause was fibrosing mediastinitis. Covered stents were placed in 17 (36%) of the patients, and 30 (64%) patients had an uncovered stent. Clinical and treatment outcomes, complications, and the percent stenosis of each stent were evaluated. RESULTS: Technical success was achieved in all cases at first attempt. Average clinical and imaging follow-up in years was 2.7 (range 0.1–11.1) (covered) and 1.7 (range 0.2–10.5) (uncovered), respectively. There was a significant difference (p = 0.044) in the number of patients who reported a return of symptoms between the covered (5/17 or 29.4%) and uncovered (18/30 or 60%) groups. There was also a significant difference (p = < 0.001) in the mean percent stenosis after stent placement between the covered [17.9% (range 0–100) ± 26.2] and uncovered [48.3% (range 6.8–100) ± 33.5] groups. No significant difference (p = 0.227) was found in the time (days) between the date of the procedure and the date of clinical follow-up where a return of symptoms was reported [covered: 426.6 (range 28–1554) ± 633.9 and uncovered 778.1 (range 23–3851) ± 1066.8]. One patient in the uncovered group had non-endovascular surgical intervention (innominate to right atrial bypass), while none in the covered group required surgical intervention. One major complication (SIR grade C) occurred that consisted of a pericardial hemorrhagic effusion after angioplasty that required covered stent placement. There were no procedure-related deaths. CONCLUSION: Both covered and uncovered stents can be used for treating benign SVC syndrome. Covered stents, however, may be a more effective option at providing symptom relief and maintaining stent patency if validated by further studies.

The emergence of the 'Widening Participation' (WP) agenda in English Higher Education (HE) has been intensified by the shift to tuition fees of ?9000 or more. Now, universities have an obligation to devote funds to encouraging participation of students from a range of groups identified by the Office for Fair Access as being under-represented and disadvantaged. For a discipline like Politics/International Relations, with implicit concerns for the examination of concepts such as social justice, there is both prima facie reason and intellectual capacity for engagement in WP programmes. In this article, we explore the tension between 'intrinsic' 'professional' WP and 'instrumental' 'academic' WP, arguing that a number of pressures need to be navigated in order for academics to engage successfully in such work. We advance an approach to maximising the value of WP programmes for academics by way of illustrating the considerations, costs and benefits of engaging with the agenda. While the article draws on experience in England, the implications are relevant to the profession in most industrialised countries, since growing inequality and the rising cost of HE study mean that WP is an agenda which will only expand.

Importance Advanced age-related macular degeneration (AMD) is a leading cause of blindness in Western countries. Causal, modifiable risk factors need to be identified to develop preventive measures for advanced AMD. Objective To assess whether smoking, alcohol consumption, blood pressure, body mass index, and glycemic traits are associated with increased risk of advanced AMD. Design, Setting, Participants This study used 2-sample mendelian randomization. Genetic instruments composed of variants associated with risk factors at genome-wide significance (P

This article draws upon clinical experience of GPs working in a deprived area of the North East of England to examine the potential contribution of Universal Basic Income to health by mitigating ‘patient-side barriers’ among three cohorts experiencing distinct forms of ‘precariousness’: 1) long-term unemployed welfare recipients with low levels of education (lumpenprecariat); 2) workers on short-term/zero-hours contracts with low levels of education (‘lower’ precariat); 3) workers on short-term/zero-hours contracts with relatively high levels of education (‘upper’ precariat). We argue that any benefits must be accompanied by robust institutions capable of promoting health.

BACKGROUND AND PURPOSE: Despite the frequent use of unenhanced head CT for the detection of acute neurologic deficit, the radiation dose for this exam varies widely. Our aim was to evaluate the performance of lower-dose head CT for detection of intracranial findings resulting in acute neurologic deficit. MATERIALS AND METHODS: Projection data from 83 patients undergoing unenhanced spiral head CT for suspected neurologic deficits were collected. Cases positive for infarction, intra-axial hemorrhage, mass, or extra-axial hemorrhage required confirmation by histopathology, surgery, progression of findings, or corresponding neurologic deficit; cases negative for these target diagnoses required negative assessments by two neuroradiologists and a clinical neurologist. A routine dose head CT was obtained using 250 effective mAs and iterative reconstruction. Lower-dose configurations were reconstructed (25-effective mAs iterative reconstruction, 50-effective mAs filtered back-projection and iterative reconstruction, 100-effective mAs filtered back-projection and iterative reconstruction, 200-effective mAs filtered back-projection). Three neuroradiologists circled findings, indicating diagnosis, confidence (0–100), and image quality. The difference between the jackknife alternative free-response receiver operating characteristic figure of merit at routine and lower-dose configurations was estimated. A lower 95% CI estimate of the difference greater than −0.10 indicated noninferiority. RESULTS: Forty-two of 83 patients had 70 intracranial findings (29 infarcts, 25 masses, 10 extra- and 6 intra-axial hemorrhages) at routine head CT (CT dose index = 38.3 mGy). The routine-dose jackknife alternative free-response receiver operating characteristic figure of merit was 0.87 (95% CI, 0.81–0.93). Noninferiority was shown for 100-effective mAs iterative reconstruction (figure of merit difference, −0.04; 95% CI, −0.08 to 0.004) and 200-effective mAs filtered back-projection (−0.02; 95% CI, −0.06 to 0.02) but not for 100-effective mAs filtered back-projection (−0.06; 95% CI, −0.10 to −0.02) or lower-dose levels. Image quality was better at higher-dose levels and with iterative reconstruction (P < .05). CONCLUSIONS: Observer performance for dose levels using 100–200 eff mAs was noninferior to that observed at 250 effective mAs with iterative reconstruction, with iterative reconstruction preserving noninferiority at a mean CT dose index of 15.2 mGy.

OBJECTIVE. The purpose of this study was to determine whether application of a proprietary image-processing algorithm would allow a reduction in the necessary administered activity for molecular breast imaging (MBI) examinations. MATERIALS AND METHODS. Images from standard-dose MBI examinations (300 MBq 99mTc-sestamibi) of 50 subjects were analyzed. The images were acquired in dynamic mode and showed at least one breast lesion. Half-dose MBI examinations were simulated by summing one-half of the dynamic frames and were processed with the algorithm under study in both a default and a preferred filter mode. Two breast radiologists independently completed a set of two-alternative forced-choice tasks to compare lesion conspicuity on standard-dose images, half-dose images, and the algorithm-processed half-dose images in both modes. RESULTS. Relative to the standard-dose images, the half-dose images were preferred in 4, the default-filtered half-dose images in 50, and preferred-filtered half-dose images in 76 of 100 readings. Compared with standard-dose images, in terms of lesion conspicuity, the half-dose images were rated better in 2, equivalent in 6, and poorer in 92 of 100 readings. The default-filtered half-dose images were rated better, equivalent, or poorer in 13, 73, and 14 of 100 readings. The preferred-filtered half-dose images were rated as better, equivalent, or poorer in 55, 34, and 11 of 100 readings. CONCLUSION. Compared with that on standard-dose images, lesion conspicuity on images obtained with the algorithm and acquired at one-half the standard dose was equivalent or better without compromise of image quality. The algorithm can also be used to decrease imaging time with a resulting increase in patient comfort and throughput.

Background Cancer patients have a higher risk of thromboembolic events but it is not well known if these patients also have a higher risk of death, myocardial infarction (MI) or repeat revascularization after percutaneous coronary intervention (PCI) is unknown. Methods Cancer patients who underwent first-time single vessel PCI from January 1, 2003, through December 31, 2013 were identified by cross-matching of institutional cancer and PCI registries. These cancer patients were matched 4:1 to non-cancer patients, likewise undergoing first-time single vessel PCI in the time period. The combined primary endpoint was death, MI and revascularization at 5 year follow-up. Secondary endpoints were death and MI combined and the individual components of the primary endpoint. Both time dependent and non-time-dependent analyses were conducted. Results A total of 712 cancer patients were identified and matched to 2,848 non-cancer patients (one third women in either group). Bare-metal stents were used in one third of patients in both groups. The combined primary study endpoint was significantly more frequently encountered in the cancer than in the non-cancer group in both time-dependent (Figure 1) and non-time dependent analyses (5-year event rate 48.6% vs. 31.2%, p Figure 1. MI + revascularization-survival Conclusion Cancer patients have a two times higher rate of death and a three times higher rate of MI over the first 5 years after PCI. Future studies will need to define the etiology and factors accounting for this higher event rate in cancer patients, especially of these patients are predisposed to stent thrombosis and need longer term dual antiplatelet therapy.

Prior iterative reconstruction (PIR) uses spatial information from one phase of enhancement to reduce image noise in other phases. We sought to determine if PIR could reduce radiation dose while preserving observer performance and CT number at multi-phase dual energy (DE) renal CT. CT projection data from multi-phase DE renal CT examinations were collected. Images corresponding to 40% radiation dose were reconstructed using validated noise insertion and PIR. Three genitourinary radiologists examined routine and 40% dose PIR images. Probability of malignancy was assessed [from 0 to 100] with malignancy assumed at probability ≥ 75. Observer performance was compared on a per patient and per lesion level. CT number accuracy was measured. Twenty-three patients had 49 renal lesions (11 solid renal neoplasms). CT number was nearly identical between techniques (mean CT number difference: unenhanced 2 ± 2 HU; enhanced 4 ± 4 HU). AUC for malignancy was similar between multi-phase routine dose DE and lower dose PIR images [per patient: 0.950 vs. 0.916 (p = 0.356); per lesion: 0.931 vs. 0.884 (p = 0.304)]. Per patient sensitivity was also similar (78% routine dose vs. 82% lower dose [p ≥ 0.99]), as was specificity (91% routine dose vs. 93% lower dose PIR [p > 0.99]), with similar findings on a per lesion level. Subjective image quality was also similar (p = 0.34). Prior iterative reconstruction is a new reconstruction method for multi-phase CT examinations that promises to facilitate radiation dose reduction by over 50% for multi-phase DE renal CT exams without compromising CT number or observer performance.

Chronic exertional compartment syndrome (CECS) is an exercise-induced condition, in which high pressure develops in one or several lower leg compartments, resulting in pain, numbness, and temporary muscle paresis. Diagnosis of CECS is assisted by measurements of intracompartment pressures (ICP) at rest, 1-min and 5-min after cessation of running exercise (Pedowitz criteria). ICP is measured via needle manometry, which is an invasive procedure. We have recently shown that intramuscular pressure is correlated to shear modulus measured via shear wave elastography (SWE) (Spearman's correlation coefficient = 0.99). The objectives of this study were to quantify temporal changes in shear modulus of muscle in lower leg compartments of healthy individuals before and after running exercise, and to evaluate a Pedowitz-like criterion for diagnosis of CECS using muscle shear modulus as biomarker. Specifically, the shear modulus of the tibialis anterior (TA) and peroneus longus (PL) was measured at time intervals of 1 min for 10 min after cessation of exercise. The shear modulus of the TA, PL, Soleus and Tibialis posterior were also measured bilaterally before, and at 1- and 5-min after exercise in a procedure that resembles the Pedowitz test for ICP. The shear modulus of all compartments increased significantly in both legs 1-min postexercise and gradually decreased to prerunning values. 50% of such decrease occurred at between 3 and 5 min after cessation of exercise. Additionally, the change in shear modulus followed a similar pattern than ICP in the Pedowitz-like protocol. Therefore, SWE has the potential to diagnose CECS noninvasively.

Background Identification of the central sulcus can require inspection of subtle differences or require certain pulse sequences. This study identifies the central sulcus by signal intensity on Double Inversion Recovery (DIR) images in multiple anatomic locations and imaging planes. Methods 49 patients (98 hemispheres) were retrospectively reviewed by three neuroradiologists and one radiology resident. The central sulcus was compared to the surrounding sulci for differences in signal intensity at axial hand knob, axial operculum, and lateral convexity sagittal images (294 locations) on DIR images. The use of the 'disappearing central sulcus sign' where the window level is increased at constant width and black/white inversion were also assessed. Results In 49 patients (22 female, 27 male; median age 36 years), the central sulcus cortex signal intensity was lower than adjacent sulci with a frequency of 90/98 (91.8%) at the axial hand knob level, 68/98 (69.4%) at the axial operculum level, and 76/98 (77.5%) at the sagittal level. With black and white inversion, the frequencies were of 96/98 (98%), 92/98 (94%), and 87/98 (89%). The central sulcus was the first to disappear at all three levels with high degrees of inter-reader agreement (86%-99%). Traditional anatomic landmarks were absent or conflicting in seven hemispheres (5 patients). The central sulcus was identified by DIR signal intensity in all seven hemispheres. Conclusions The central sulcus can be identified by differences in signal intensity of the peri-rolandic cortex on DIR. Use of black/white inversion and the disappearing central sulcus sign may further facilitate identification.

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant multi-organ vascular disorder that commonly affects the gastrointestinal tract and the liver resulting in telangiectasias and arteriovenous malformations (AVMs). Previous studies looking at the prevalence of liver and abdominal organ involvement in HHT have been limited by differing imaging techniques and sample size limitations. We sought to define the prevalence of HHT related abdominal vascular abnormalities using optimized multiphasic contrast-enhanced abdominal computed tomography (CT) exams in a large cohort of HHT patients. Between January 2001 and May 2015; we identified a total of 333 consecutive HHT patients who had undergone a dedicated HHT protocol multiphase abdominal CT at our institution. The CT exams were reviewed by three board certified abdominal radiologists for the presence of vascular abnormalities involving the liver, pancreas, spleen, and other abdominal organs. Vascular abnormalities involving the liver were further categorized as telangiectasias, large confluent vascular masses, perfusion abnormalities, or hepatic shunts. In patients with abdominal vascular abnormalities, the liver was the most commonly involved organ, with 180 out of 333 (54.1%) patients demonstrating at least one hepatic vascular abnormality (telangiectasia, confluent vascular mass, transient perfusion abnormalities, and hepatic shunts), with most (70.0%) demonstrating multiple hepatic vascular abnormalities. The other most common organs involved included the pancreas (18.0%), spleen (6.3%), and small bowel (4.5%). In patients with the clinical diagnosis of HHT, greater than half demonstrate an abdominal vascular abnormality, with the most commonly involved organ being the liver. These may be under recognized on routine or single phase contrast-enhanced CT of the abdomen. This supports the use of optimized multiphasic abdominal CT exams as an important tool for the evaluation and screening of patients with HHT.

How should academic staff engage in outreach with communities outside of the university? The need of academics to answer this question has intensified in the UK given the changing priorities of academic job roles, shaped by increasing institutional concern for widening participation, graduate employability and research impact in an era of austerity and high tuition fees. While university outreach professionals, such as those in widening participation, have access to a range of networks, resources and support mechanisms for outreach activity, academics often face a series of profession-specific pressures that make engagement in outreach complex and contingent. This article draws upon the experience of 25 academics from 18 different subject areas and 18 institutions to examine and provide responses to key challenges faced by academics involved in outreach in the UK. We examine such issues as: the conceptualisation of outreach; funding; recognition and management of workload; nurturing relationships with internal and external partners; capacity-building; commercial interests, payment and responsibility; pedagogical style and content; integration of outreach into curricula, and evaluation of programmes. The examination offered is not all encompassing, but acts as a series of reference points to consider the challenges faced by UK academics in an evolving outreach sector.

OBJECTIVE: Preeclampsia is a common and serious heritable disorder of human pregnancy. Although there have been notable successes in identification of maternal susceptibility genes a large proportion of the heritability of preeclampsia remains unaccounted for. It is has been postulated that rare variation may account for some of this missing heritability. In this study, we performed whole-exome sequencing (WES) in multiplex families to identify rare exonic risk variants. METHODS: We conducted WES in 244 individuals from 34 Australian/New Zealand multiplex preeclampsia families. Variants were tested for association with preeclampsia using a threshold model and logistic regression. RESULTS: We found significant association for two moderately rare missense variants, rs145743393 (Padj = 0.0032, minor allele frequency = 0.016) in the chromosome 1 open reading frame 35 (C1orf35) gene, and rs34270076 (Padj = 0.0128, minor allele frequency = 0.024) in the pyroglutamylated RFamide peptide receptor (QRFPR) gene. To replicate these associations we performed imputation in our Australian genome wide association scan for preeclampsia and found no significant exonic variants in either C1orf35 or QRFPR. However, 11 variants demonstrating nominal significance (P

NASA and the international aviation community are investing in the development of a commercial transportation infrastructure that includes the increased use of rotorcraft, specifically helicopters and civil tilt rotors. However, there is significant concern over the impact of noise on the communities surrounding the transportation facilities. One way to address the rotorcraft noise problem is by exploiting powerful search techniques coming from artificial intelligence to design low-noise flight profiles that can be then validated though field tests. This article investigates the use of discrete heuristic search methods to design low-noise approach trajectories for rotorcraft. Our work builds on a long research tradition in trajectory optimization using either numerical methods or discrete search. Novel features of our approach include the use of a discrete search space with a resolution that can be varied, and the coupling of search with a robust simulator to evaluate candidates. The article includes a systematic comparison of different search techniques; in particular, in the experiments, we are able to do a trade study that compares complete search algorithms such as A * with faster but approximate methods such as local search.

Ocular disease is a major public health concern worldwide, including Asia where large numbers of individuals suffer from blindness and visual impairment. In South Asian countries like Nepal, for example, age-related cataract is a leading cause of blindness and visual impairment. Age-related cataract is influenced by a complex interplay of non-genetic and genetic risk factors. Identifying the genetic risk factors involved can help elucidate the causal biological mechanisms underlying the development and progression of cataract and help identify those individuals at high risk of disease. The primary objective of an ongoing study in the Jirel ethnic group of eastern Nepal (the Jiri Eye Study) is to define the genetic architecture of normal ocular trait variation and characterize genetic factors influencing risk for common ocular diseases such as cataract. The Jirel population has been the focus of genetic epidemiological studies for more than two decades, and a well-documented extended pedigree has been developed for the group making it extremely powerful and informative for genetic studies. All 1292 study participants discussed in the work presented here belong to this single extended pedigree. Members of the Jirel population underwent a comprehensive eye examination that included lens opacity grading in accordance with the Lens Opacities Classification System II (LOCS II). A variance components method was used to estimate heritability of cataract. Of the 1292 participants, 57.0% were female and 43.0% were male. The mean (SD, range) age at exam is 42.0 (16.7, 18–88) years. The prevalence of cataract (any type) in individuals aged 40 years or older is 25.8%, and additive genetic effects (48.3%) play a significant role in determining the risk of developing cataract in this population. The Jirel population is a powerful resource for the study and identification of genetic mechanisms influencing variation observed in ocular health and disease metrics. We anticipate that the Jiri Eye Study will continue to make significant contributions to the genetics of ocular health and disease in Asia.

Introduction Iron deficiency (ID) and iron deficiency anaemia (IDA) are frequent complications of Crohn’s disease (CD) and Ulcerative Colitis (UC). Assessing iron status in IBD patients can be challenging as tests may be unreliable in the presence of inflammation. European Crohn’s and Colitis Organisation (ECCO) guidelines state FBC, CRP and ferritin are the minimum to detect IDA. The UK IBD audit of inpatient care found 56% of those with IDA did not receive iron, but the standard of care for IBD outpatients is unknown. IBD patients with IDA rarely have an iron deficit of Initial pilot data on ID/IDA diagnosis is presented from a Joint Working project using an adapted Webtool with anaemia specific parameters to determine the standard of care for IBD outpatients. Methods 20 consecutive consented patients (10 CD, 10 UC) were recruited at 5 sites and followed for around 12 months. Anaemia: Hb ID: MCV 5 mg/ml AND/OR TSAT IDA: Anaemia and ID Results Baseline data were available for 94 patients: 45 (48%) male and 49 (52%) female, 47 (50%) with CD and 45 (48%) with UC (2 patients with unidentified IBD) mean age 46.5 years. 82 patients had ≥1 recorded haematinic and 18 of these (22%) had 26 anaemic episodes, with 10 (56%, 5 UC and 5 CD) and 14 (54%) of these patients and episodes being IDA. 23 (28%, 8 CD, 14 UC, 1 undefined IBD) patients experienced 34 episodes of ID. 136 Hb results were recorded, but only 78 (57%) were combined with ferritin plus CRP. Conclusions Most cases of anaemia were IDA, and more episodes of ID than IDA were found. An equal number of CD and UC patients had IDA, but non-anaemic ID was more common in UC than CD patients. As only 57% of haematinic tests fulfilled the minimum requirement to detect ID in anaemic IBD patients (Hb combined with ferritin plus CRP) ID/IDA may be significantly underdiagnosed conditions in IBD. However, these findings are limited due to the small, real-world, dataset. An adapted Registry Webtool may allow easy data collection though there are challenges in completing data input during consultations. Iron status could therefore be better monitored if haematinics were a default part of the IBD Registry dataset, allowing for quality improvement.

Background Hypertension is a common and difficult-to-treat condition; digital health tools may serve as adjuncts to traditional pharmaceutical and lifestyle-based interventions. Using a retrospective observational study we sought to evaluate the effect of a desktop and mobile digital health intervention (DHI) as an adjunct to a workplace health program in those previously diagnosed with hypertension. Methods As part of a workplace health program, 3330 patients were identified as previously diagnosed with hypertension. A DHI was made available to participants providing motivational and educational materials assisting in the management of hypertension. We evaluated changes in blood pressure, weight, and body mass index (BMI) between users and nonusers based on login frequency to the DHI using multivariate regression through the five visits over the course of 1 year. Results One thousand six hundred twenty-two (49%) participants logged into the application at least once. DHI users had significant greater improvements in systolic blood pressure (SBP; −2.79 mm Hg), diastolic blood pressure (−2.12 mm Hg), and BMI (−0.23 kg/m2) at 1 year. Increased login frequency was significantly correlated with reductions in SBP, diastolic blood pressure, weight, and BMI (P ≤ .014). Discussion This large, observational study provides evidence that a DHI as an adjunct to a workplace health program is associated with greater improvement in blood pressure and BMI at 1 year. This study adds to the growing body of evidence that DHIs may be useful in augmenting the treatment of hypertension in addition to traditional management with pharmaceuticals and lifestyle changes.

We study the r -gather clustering problem in a mobile and distributed seŠing. In this problem, nodes must be clustered into groups of at least r nodes each, and the goal is to minimize the diameter of the clusters. This notion of clustering is motivated by protecting user anonymity in location-based services or trajectorypublication. Prior works on r -gather problems are centralized and cannot be easily adapted to the mobile setting. We describe a distributed algorithm that produces compact clusters, within an approximation factor 4 of the minimum cluster diameter possible. The algorithm can run on the mobile nodes and access points at the network edge locally, and can handle node mobility, rapidlyswitching cluster memberships as needed. The distributed approach naturally comes with the advantage of greater resilience and stability. Additionally, we show that it achieves local optimality; i.e., from the point of view of any particular node, the solution is nearly as favorable as possible, irrespective of the global con€figuration. We also show how to cluster trajectories with dynamic regroupings. Further, we improve the theoretical hardness results for the problem in the Euclidean setting.

We study a data dissemination scenario in which data items are to be transmitted to mobile clients via one of the stationary data access points (APs) that the clients pass by en route to their destinations. The scheduler dedicates sequences of consecutive timeslots of an AP to downloading a data item to a client during the time window in which it is in range, which corresponds to assigning a job (the client's download) to a machine (the AP) among many. The transmission rate chosen for each assignment partly corresponds to setting a machine's speed, but it also has subtler effects. The APs may control transmission power to tune its transmission range making sure that no interference occurs with neighboring APs' transmissions. The problem is a generalization of an already NP-hard parallel-machine scheduling problem in which jobs' release times and deadlines depend on the machine to which they are assigned. We define this joint timeslot, power control, and rate assignment problem formally and apply both new algorithms and adaptations of existing algorithms to it. We evaluate these algorithms through simulations which show that our proposed algorithms achieve near-optimal throughput.

Using social media during natural disasters has become commonplace globally. In the U.S., public social media platforms are often a go-to because people believe: the 9-1-1 system becomes overloaded during emergencies and that first responders will see their posts. While social media requests may help save lives, these posts are difficult to find because there is more noise on public social media than clear signals of who needs help. This study compares human-coded images posted during 2017's Hurricane Harvey to machine-learned ‘deep learning’ classification methods. Our framework for feature extraction uses the VGG-16 convolutional neural network/multilayer perceptron classifiers for classifying the urgency and time period for a given image. We find that our qualitative results showcase that unique disaster experiences are not always captured through machine-learned methods. These methods work together to parse through the high levels of non-relevant content on social media to find relevant content and requests. Keywords: Social media, Disasters, Deep learning, Content analysis, Twitter, Images, Rescue

Patients with a prior history of coronary artery bypass grafting (CABG) undergoing primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) are frequently encountered. Little is known regarding long term outcomes with respect to culprit (i.e, native vs graft)