Brazilian fossils reveal homoplasy in the oldest mammalian jaw joint.

The acquisition of the load-bearing dentary-squamosal jaw joint was a key step in mammalian evolution1-5. Although this innovation has received decades of study, questions remain over when and how frequently a mammalian-like skull-jaw contact evolved, hindered by a paucity of three-dimensional data spanning the non-mammaliaform cynodont-mammaliaform transition. New discoveries of derived non-mammaliaform probainognathian cynodonts from South America have much to offer to this discussion. Here, to address this issue, we used micro-computed-tomography scanning to reconstruct the jaw joint anatomy of three key probainognathian cynodonts: Brasilodon quadrangularis, the sister taxon to Mammaliaformes6-8, the tritheledontid-related Riograndia guaibensis9 and the tritylodontid Oligokyphus major. We find homoplastic evolution in the jaw joint in the approach to mammaliaforms, with ictidosaurs (Riograndia plus tritheledontids) independently evolving a dentary-squamosal contact approximately 17 million years before this character first appears in mammaliaforms of the Late Triassic period10-12. Brasilodon, contrary to previous descriptions6-8, lacks an incipient dentary condyle and squamosal glenoid and the jaws articulate solely using a plesiomorphic quadrate-articular joint. We postulate that the jaw joint underwent marked evolutionary changes in probainognathian cynodonts. Some probainognathian clades independently acquired 'double' craniomandibular contacts, with mammaliaforms attaining a fully independent dentary-squamosal articulation with a conspicuous dentary condyle and squamosal glenoid in the Late Triassic. The dentary-squamosal contact, which is traditionally considered to be a typical mammalian feature, therefore evolved more than once and is more evolutionary labile than previously considered.

Widespread convergence towards functional optimization in the lower jaws of crocodile-line archosaurs.

Extant crocodilian jaws are subject to functional demands induced by feeding and hydrodynamics. However, the morphological and ecological diversity of extinct crocodile-line archosaurs is far greater than that of living crocodilians, featuring repeated convergence towards disparate ecologies including armoured herbivores, terrestrial macropredators and fully marine forms. Crocodile-line archosaurs, therefore, present a fascinating case study for morphological and functional divergence and convergence within a clade across a wide range of ecological scenarios. Here, we build performance landscapes of two-dimensional theoretical jaw shapes to investigate the influence of strength, speed and hydrodynamics in the morphological evolution of crocodile-line archosaur jaws, and test whether ecologically convergent lineages evolved similarly optimal jaw function. Most of the 243 sampled jaw morphologies occupy optimized regions of theoretical morphospace for either rotational efficiency, resistance to Von Mises stress, hydrodynamic efficiency or a trade-off between multiple functions, though some seemingly viable shapes remain unrealized. Jaw speed is optimized only in a narrow region of morphospace whereas many shapes possess optimal jaw strength, which may act as a minimum boundary rather than a strong driver for most taxa. This study highlights the usefulness of theoretical morphology in assessing functional optimality, and for investigating form-function relationships in diverse clades.

Short-Term Strategies for Augmenting the National Radiologist Workforce.

The current radiology landscape has an imbalance between the rising demand for radiology services and the national radiologist workforce available. More vacant radiology positions exist than graduating radiology trainees. The origins of this problem are complex and require long-term solutions. Rather than working longer and/or faster, radiologists can work smarter. In this article, we present multiple short-term strategies to increase the effective radiologist workforce and/or increase workforce efficiency, to alleviate the current workload challenges. These strategies are derived from an analysis of possible practice-level changes in personnel, process, and physical plant. The impacts of the potential changes are estimated. No single change addresses the mismatch between supply and demand for radiology services. By creating an inventory of potential solutions, practices can choose the potential mechanism(s) to address the workforce shortage that best fit their needs and local environment.

Liberating Structures in Strategic Planning: Methods to Foster Engagement.

This paper describes the innovative approach of using liberating structures to the development of the AUR 2023 strategic plan, and lessons learned in their application. The 2023 strategic plan built on the results and approach of the prior 2015 plan. Similar to the 2015 strategic plan, traditional tools such as a SWOT analysis and strategic retreat were used. In addition, the 2023 process included tools called liberating structures and was iteratively co-produced through a series of virtual meetings over 18 months. Advantages of liberating structures included increased creativity and speed in moving through meeting tasks, increased number of meaningful contributions from AUR members and increased engagement from participants during discussions and meetings. The 2023 AUR strategic plan is provided along with examples of completed goals and those under early implementation. Lessons learned from using these tools for strategic planning can be applied to other society and group meetings. Moving forward, the 2023 strategic plan will be a living document, which will be reviewed at each Board of Directors meeting and periodically adapted.

Quality Improvement Report: Adherence to Follow-up Recommendations for Incidental Abdominal Aneurysms.

The use of national guidelines for the management of incidental radiologic findings remains low. Therefore, improving adherence to and consistency with follow-up recommendations for incidental findings was undertaken in a large academic practice. A gap analysis was performed, and incidental findings of abdominal aneurysms for which reporting management recommendations could be improved were identified. The Kotter change management framework was used, and institution-specific dictation macros were developed and implemented in February 2021 for the management of abdominal aortic aneurysms (AAAs), renal artery aneurysms (RAAs), and splenic artery aneurysms (SAAs). A retrospective medical record review was conducted for February through April in 2019, 2020, and 2021 to assess reporting adherence and imaging and clinical follow-up. Personal feedback was provided to radiologists in July 2021 with repeat data collection in September 2021. A significant increase in the number of correct follow-up recommendations was reported for incidental AAAs and SAAs after implementation of the macro (P < .001). However, there was no significant change for RAAs. Providing personal feedback to radiologists further improved adherence with standard recommendation macros for common findings and dramatically increased adherence for rare findings such as RAAs. New macros resulted in an increase in AAA and SAA imaging follow-up (P < .001). Institution-specific dictation macros were found to improve adherence to reporting recommendations for incidental abdominal aneurysms, with further improvement seen after feedback, which can have a significant effect on clinical follow-up. © RSNA, 2023.

Scenario Planning Approach to Adapting in the COVID Era.

RATIONALE AND OBJECTIVES: The COVID-19 pandemic has caused much uncertainty and disruption in healthcare resulting in many challenges for strategic planning. Scenario planning is a tool that allows healthcare leaders to plan healthcare delivery strategies by incorporating the uncertainties into the analysis and planning process. MATERIALS AND METHODS: Variables were identified which will have major impact on the future, but whose future direction is uncertain. The extremes of these drivers were used to generate multiple scenarios. A subset of scenarios was used to evaluate potential tactics to determine which may be high yield in the face of uncertainty. RESULTS: Unlike traditional strategic planning, scenario planning does not develop a single future with a path to that future. Scenario planning evaluates tactics to determine which would be helpful in specific scenarios, multiple different futures or under specific conditions. CONCLUSION: We present a scenario planning model which can be used to determine specific tactics to accommodate the uncertainty due to variable healthcare delivery needs in the COVID-19 era.

Early tetrapod cranial evolution is characterized by increased complexity, constraint, and an offset from fin-limb evolution.

The developmental underpinnings and functional consequences of modifications to the limbs during the origin of the tetrapod body plan are increasingly well characterized, but less is understood about the evolution of the tetrapod skull. Decrease in skull bone number has been hypothesized to promote morphological and functional diversification in vertebrate clades, but its impact during the initial rise of tetrapods is unknown. Here, we test this by quantifying topological changes to cranial anatomy in fossil and living taxa bracketing the fin-to-limb transition using anatomical network analysis. We find that bone loss across the origin of tetrapods is associated not only with increased complexity of bone-to-bone contacts but also with decreasing topological diversity throughout the late Paleozoic, which may be related to developmental and/or mechanical constraints. We also uncover a 10-Ma offset between fin-limb and cranial morphological evolution, suggesting that different evolutionary drivers affected these features during the origin of tetrapods.

Prospective Analysis of Radiology Resource Utilization and Outcomes for Participation in Oncology Multidisciplinary Conferences.

RATIONALE AND OBJECTIVES: Radiology participation is necessary in oncology multidisciplinary conferences (MDCs), but the resources required to do so are often unaccounted for. In this prospective study we provide an analysis of resource utilization as a function of outcomes for all MDCs covered by an entire radiology section and provide a time-based cost estimate. MATERIALS AND METHODS: Following institutional review board approval, prospective data on all MDCs covered by abdominal radiologists at a single tertiary care academic center were obtained over nine weeks. A predefined questionnaire was used by a single observer who attended every imaging review and recorded the total time spent by the radiologists and several outcome measures. The total time recorded was used to provide a time-based cost estimate using a national salary survey. RESULTS: Six radiologists participated in a total of 57 MDCs, with 577 cases reviewed and discussed. 181 (31%) cases were performed at outside facilities requiring full reinterpretation. Clinically significant revisions to original reports were recorded in 107 (18.5%) cases. Radiologist input directly resulted in alteration of cancer staging in 65 (11%) patients and specific recommendations for follow-up diagnostic workup in 280 (48%) of cases. The mean total time devoted by the staff radiologist per week to MDCs was 18.7 hours/week, nearly a half of full-time effort, or 8% of total effort per radiologist. The total annual projected cost of radiology coverage for each weekly MDC was $26,920. CONCLUSION: Section-wide radiologist participation in MDCs directly resulted in change in clinical management in nearly half of reviewed cases. This was achieved at a notable time cost, highlighting the need for efficient integration of radiology MDC participation into radiologist workflow and compensation models.

Operational Radiology Recovery in Academic Radiology Departments After the COVID-19 Pandemic: Moving Toward Normalcy.

This article presents a current snapshot in time, describing how radiology departments around the country are planning recovery from the baseline of the coronavirus disease 2019 pandemic, with a focus on different domains of recovery such as managing appointment availability, patient safety and workflow changes, and operational data and analytics. An e-mail survey was sent through the Society of Chairs of Academic Radiology Departments list server to 114 academic radiology departments. On the basis of data reported by the 38 survey respondents, best practices and shared experience are described for three key areas: (1) planning for recovery, (2) creating a new normal, and (3) measuring and forecasting. Radiology practices should be aware of the common approaches and preparations academic radiology departments have taken to reopening imaging in the post-coronavirus disease 2019 world. This should all be done when maintaining a safe and patient-centric environment and preparing to minimize the impact of future outbreaks or pandemics.

Nomogram Identifies Age as the Most Important Predictor of Overall Survival in Oral Cavity Squamous Cell Cancer After Primary Surgery.

Our goal was to determine the most important predictors and construct a nomogram for overall survival (OS) in oral cavity squamous cell cancer (OCSCC) treated with primary surgery followed by observation, adjuvant radiation or chemoradiation. Multivariable analysis was performed using Cox Proportional Hazard model of 9258 OCSCC patients from Surveillance, Epidemiology and End Results Program (SEER) database treated with surgery from 2003 to 2009. Potential predictors of OS were age, gender, race, tobacco use, oral cancer sub-sites, pathologic tumor stage and grade, pathologic nodal stage, extra-capsular invasion, clinical levels IV and V involvement, and adjuvant treatment selection. Weighted propensity scores for treatment were used to balance observed baseline characteristics between three treatment groups in order to reduce bias. Following primary surgery, patients underwent observation (56%), radiation alone (31%) or chemoradiation (13%). All tested predictors were statistically significant and included in our final nomogram. Most important predictor of OS was age, followed by pathologic tumor stage. SEER based-survival nomogram for OCSCC patients differs from published models derived from patients treated in a single or few academic treatment centers. An unexpected finding of patient age being the best OS predictor suggests that this factor may be more critical for the outcome than previously anticipated.

Fortifying Our Teams to Best Serve Our Patients: A Report of the 2019 Summer Intersociety Meeting.

Continuing the thematic focus on fostering wellness and professional fulfillment in our workplace, the 2019 Radiology Intersociety Committee Conference focused on understanding and leading multigenerational workforces and developing high-functioning teams. To lead a multigenerational workforce and to understand and embrace traditional versus emerging cultures in our workplace, effective leaders should foster diversity of their teams. Sustaining such teams requires an understanding of different styles and preferences for bidirectional communication and clarity of information sharing and learning; active efforts may be needed to focus on practical approaches to succession planning, breaking down traditional hierarchies, clarifying role delineation, and managing authority gradients. An effective team requires attention to the well-being of team members and professional behavior in and out of the workplace. Conference participants unanimously endorsed multi-organizational support statements and activities assuring professional behavior of their members, along with the desire to explore codes of conduct and ethics.

A Road Map to Foster Wellness and Engagement in Our Workplace-A Report of the 2018 Summer Intersociety Meeting.

The 2018 radiology Intersociety Committee reviewed the current state of stress and burnout in our workplaces and identified approaches for fostering engagement, wellness, and job satisfaction. In addition to emphasizing the importance of personal wellness (the fourth aim of health care), the major focus of the meeting was to identify strategies and themes to mitigate the frequency, manifestations, and impact of stress. Strategies include reducing the stigma of burnout, minimizing isolation through community building and fostering connectivity, utilizing data and benchmarking to guide effectiveness of improvement efforts, resourcing and training "wellness" committees, acknowledging value contributions of team members, and improving efficiency in the workplace. Four themes were identified to prioritize organizational efforts: (1) collecting, analyzing, and benchmarking data; (2) developing effective leadership; (3) building high-functioning teams; and (4) amplifying our voice to increase our influence.

Gender Diversity in Academic Radiology Departments: Barriers and Best Practices to Optimizing Inclusion and Developing Women Leaders.

Gender diversity remains a challenge for radiology. As we aspire to embrace Diversity 3.0 and the goal of making diversity core to our organizations' mission, there must be increasing awareness of the barriers to achieving inclusion and to best practices for making diversity integral to achieving excellence. This article reviews the literature on gender diversity in radiology and in academic radiology leadership and discusses lessons learned from non-health-care industry and from academic radiology departments that have been successful in developing and supporting female employees.