Measurement of the Positive Muon Anomalous Magnetic Moment to 0.20 ppm.

We present a new measurement of the positive muon magnetic anomaly, a_{µ}≡(g_{µ}-2)/2, from the Fermilab Muon g-2 Experiment using data collected in 2019 and 2020. We have analyzed more than 4 times the number of positrons from muon decay than in our previous result from 2018 data. The systematic error is reduced by more than a factor of 2 due to better running conditions, a more stable beam, and improved knowledge of the magnetic field weighted by the muon distribution, ω[over ˜]_{p}^{'}, and of the anomalous precession frequency corrected for beam dynamics effects, ω_{a}. From the ratio ω_{a}/ω[over ˜]_{p}^{'}, together with precisely determined external parameters, we determine a_{µ}=116 592 057(25)×10^{-11} (0.21 ppm). Combining this result with our previous result from the 2018 data, we obtain a_{µ}(FNAL)=116 592 055(24)×10^{-11} (0.20 ppm). The new experimental world average is a_{µ}(exp)=116 592 059(22)×10^{-11} (0.19 ppm), which represents a factor of 2 improvement in precision.

Risk factors for brachial plexus injury and permanent sequelae due to shoulder dystocia.

Aim: The primary aim of this study was to determine the risk factors for the occurrence of brachial plexus injury in cases of shoulder dystocia. Secondly, it was aimed to determine the factors affecting the occurrence of permanent sequelae in cases with brachial plexus injury. Subjects and Methods: ICD-10 codes were scanned from the records of patients who gave birth between 2012 and 2018, and the records of patients with brachial plexus injury and shoulder dystocia were reached. Shoulder dystocia cases with brachial plexus damage were accepted as the study group, and shoulder dystocia cases without brachial plexus damage were considered the control group. Shoulder dystocia patients with brachial plexus injury and without injury were compared for 2-year orthopedics clinic follow-up reports, surgical intervention, permanent sequelae status as well as birth data, maternal characteristics, and maneuvers applied to the management of shoulder dystocia. Results: Five hundred sixty births with shoulder dystocia were detected. Brachial plexus injury was observed in 88 of them, and permanent sequelae were detected in 12 of these patients. Maneuvers other than McRobert's (advanced maneuvers) were used more and clavicle fracture was seen more in the group with plexus injury (P < 0.05, P < 0.05, respectively). Logistic regression analysis was performed to determine the risk factors of brachial plexus injury. Brachial plexus injury was observed 4.746 times more in infants who were delivered with advanced maneuvers and 3.58 times more in infants with clavicle fractures at birth. Conclusion: In patients with shoulder dystocia, the risk of brachial plexus injury increased in deliveries in which advanced maneuvers were used and clavicle fracture occurred.

Measurement of the Positive Muon Anomalous Magnetic Moment to 0.46 ppm.

We present the first results of the Fermilab National Accelerator Laboratory (FNAL) Muon g-2 Experiment for the positive muon magnetic anomaly a_{µ}≡(g_{µ}-2)/2. The anomaly is determined from the precision measurements of two angular frequencies. Intensity variation of high-energy positrons from muon decays directly encodes the difference frequency ω_{a} between the spin-precession and cyclotron frequencies for polarized muons in a magnetic storage ring. The storage ring magnetic field is measured using nuclear magnetic resonance probes calibrated in terms of the equivalent proton spin precession frequency ω[over ˜]_{p}^{'} in a spherical water sample at 34.7 °C. The ratio ω_{a}/ω[over ˜]_{p}^{'}, together with known fundamental constants, determines a_{µ}(FNAL)=116 592 040(54)×10^{-11} (0.46 ppm). The result is 3.3 standard deviations greater than the standard model prediction and is in excellent agreement with the previous Brookhaven National Laboratory (BNL) E821 measurement. After combination with previous measurements of both µ^{+} and µ^{-}, the new experimental average of a_{µ}(Exp)=116 592 061(41)×10^{-11} (0.35 ppm) increases the tension between experiment and theory to 4.2 standard deviations.

Assessment of the Radiology Support, Communication and Alignment Network to Reduce Medical Imaging Overutilization: A Multipractice Cohort Study.

PURPOSE: The aim of this study was to determine whether participation in Radiology Support, Communication and Alignment Network (R-SCAN) results in a reduction of inappropriate imaging in a wide range of real-world clinical environments. METHODS: This quality improvement study used imaging data from 27 US academic and private practices that completed R-SCAN projects between January 25, 2015, and August 8, 2018. Each project consisted of baseline, educational (intervention), and posteducational phases. Baseline and posteducational imaging cases were rated as high, medium, or low value on the basis of validated ACR Appropriateness Criteria®. Four cohorts were generated: a comprehensive cohort that included all eligible practices and three topic-specific cohorts that included practices that completed projects of specific Choosing Wisely topics (pulmonary embolism, adnexal cyst, and low back pain). Changes in the proportion of high-value cases after R-SCAN intervention were assessed for each cohort using generalized estimating equation logistic regression, and changes in the number of low-value cases were analyzed using Poisson regression. RESULTS: Use of R-SCAN in the comprehensive cohort resulted in a greater proportion of high-value imaging cases (from 57% to 79%; odds ratio, 2.69; 95% confidence interval, 1.50-4.86; P = .001) and 345 fewer low-value cases after intervention (incidence rate ratio, 0.45; 95% confidence interval, 0.29-0.70; P < .001). Similar changes in proportion of high-value cases and number of low-value cases were found for the pulmonary embolism, adnexal cyst, and low back pain cohorts. CONCLUSIONS: R-SCAN participation was associated with a reduced likelihood of inappropriate imaging and is thus a promising tool to enhance the quality of patient care and promote wise use of health care resources.

Venom allergy and knowledge about anaphylaxis among beekeepers and their families.

BACKGROUND: Beekeepers and their families are at an increased risk of life-threatening anaphylaxis due to recurrent bee-sting exposures. OBJECTIVE: The aim of this study is to evaluate the demographic features, previous history of anaphylaxis among beekeepers and their family members, and their knowledge about the symptoms and management of anaphylaxis. METHODS: A standardized questionnaire was administered to beekeepers during the 6th International Beekeeping and Pine Honey Congress held in 2018, in Mugla, Turkey. Additionally, food-service staff from restaurants were surveyed as an occupational control group about their knowledge about anaphylaxis. RESULTS: Sixty-nine beekeepers (82.6% male, mean age 48.4±12.0 years) and 52 restaurant staff (46.2% male, mean age 40.5±10.0 years) completed the questionnaire. Awareness of the terms 'anaphylaxis' and 'epinephrine auto-injector' among the beekeepers were 55.1% and 30.4% and among the restaurant staff were 23.1% and 3.8%, respectively. Of the beekeepers, 74% were able to identify the potential symptoms of anaphylaxis among the given choices; 2.9% and 5.8% reported anaphylaxis related to bee-stings in themselves and in their family members, respectively. None of the restaurant staff had experienced or encountered anaphylaxis before but 3.8% of their family members had anaphylaxis and those reactions were induced by drugs. CONCLUSION: It is essential that implementation of focused training programs about anaphylaxis symptoms and signs as well as practical instructions of when and how to use an epinephrine auto-injector will decrease preventable morbidities and mortalities due to bee-stings in this selected high-risk population of beekeepers and their family members, as well as other fieldworkers under risk.

Contact sensitization in children with atopic dermatitis.

BACKGROUND: Atopic dermatitis is a common illness in childhood. Children with atopic dermatitis are prone to develop cutaneous sensitization due to skin barrier dysfunction. AIM: The aim of this study was to evaluate the frequency of cutaneous sensitizations in patients with atopic dermatitis and to identify the most frequent causative allergens. STUDY DESIGN: The study group consisted of 112 children with atopic dermatitis, aged 1-18 years (median 88.5 months) and 39 healthy controls, aged 1-8 years (median 88.48 months). METHODS: The diagnosis of atopic dermatitis was established by modified Hanifin and Rajka criteria; severity of the disease was assessed by scoring of atopic dermatitis. Serum blood eosinophil count, total IgE and skin prick tests for common aeroallergens and food allergens were performed. Patch tests with cosmetic series and European standard patch test series (Stallegenes© Ltd, Paris, France) were applied. RESULTS: Of the children with atopic dermatitis, 17% (n=19) were sensitized to either cosmetic or standard series or both of them; no children in the control group had a positive patch test (p=0.001). Atopy and severity of atopic dermatitis was not a significant risk factor for cutaneous sensitization. The most common allergens were Nickel sulphate and Methychloroisothiazinolone (4.5% and 4.5%) in the European standard patch test and cocamidoproplybetaine (12.5%) in the cosmetic series patch test. CONCLUSION: Cutaneous sensitization can develop in children with atopic dermatitis, therefore allergic contact dermatitis should be kept in mind.

Evaluation of pancreatic exocrine functions in rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is one of the most common chronic inflammatory diseases. It mainly involves the joints and also affects directly or indirectly nearly all organ systems. The question whether RA causes exocrine pancreatic disfunction remains unclear. The purpose of this study is to evaluate whether or not RA contributes to pancreatic exocrine insufficiency. This was done by ruling out seconder Sjögren's syndrome (SjS) by using Schirmer's test. METHODS: A total of 60 patients (20 RA, 20 RA + SjS and 20 SjS) and 20 healthy volunteers were included in the study. Patients with RA who had not undergonethe Schirmer's test in the last 6 months and all healthy volunteers included in the study underwent the Schirmer's test at an outpatient clinic. Random fecal samples were taken from all participants and fecal pancreatic elastase was measured to evaluate pancreatic exocrine functions. RESULTS: In the study, a statistically significant difference was found between the control group,SjS and RA+SjS groups. But there was no significant difference between the control group and RA group. In RA group, fecal elastase levels were statistically significantly higher compared to the SjS group. But there was no significant difference between RA+SjS and SjS groups. CONCLUSION: Fecal elastase significantly decreased in SjS compared to the normal population while pancreatic exocrine functions are considered to be impaired in SjS. There are also impaired pancreatic exocrine functions in the secondary SjS associated with RA. Consequently, pancreatic exocrine dysfunction, which can be seen in patients with RA, may be thought to be caused by secondary SjS associated with RA (Tab. 6, Fig. 1, Ref. 19).

Surgical Management of a Bilateral Bifid Condyle: Diagnosis, Three-dimensional Reconstruction, and Treatment - A Report of a Case and Review of the Literature.

Bifid condyle is a rare entity with a difficult diagnosis and usually identified as an incidental finding on routine radiographic examination. The etiology is not well known, possible causes may be developmental, traumatic, vascular, abnormal muscle pulling, nutritional, endocrinal, teratogenic, and infections. The orientation of the condylar heads can behelpful for the etiological diagnosis.This case report describes a 56-year-old woman who suffered from a unilateral, progressively increasing, radiating pain which intensified with the movement of the mandible and includes information about the diagnosis, management, radiographic and three-dimensional model features and review of the literature.

Anticipated Supply and Demand for Independent Interventional Radiology Residency Positions: A Survey of Department Chairs.

PURPOSE: The first participants in the independent interventional radiology (IR) residency match will begin prerequisite diagnostic radiology (DR) residencies before the anticipated launch of the independent IR programs in 2020. The aim of this study was to estimate the competitiveness level of the first independent IR residency matches before these applicants have already committed to DR residencies and possibly early specialization in IR (ESIR) programs. METHODS: The Society of Chairs of Academic Radiology Departments (SCARD) Task Force on the IR Residency distributed a survey to all active SCARD members using SurveyMonkey. The survey requested the number of planned IR residency and ESIR positions. The average, minimum, and maximum of the range of planned independent IR residency positions were compared with the average, maximum, and minimum, respectively, of the range of planned ESIR positions, to model matches of average, high, and low competitiveness. RESULTS: Seventy-four active SCARD members (56%) answered at least one survey question. The respondents' programs planned to fill, in total, 98 to 102 positions in integrated IR residency programs, 61 to 76 positions in independent IR residency programs, and 50 to 77 positions in ESIR DR residency programs each year. The ranges indicate the uncertainty of some programs regarding the number of positions. CONCLUSIONS: The survey suggests that participating programs will fill sufficient independent IR residency positions to accommodate all ESIR applicants in a match year of average or low competitiveness, but not in a match year of high competitiveness. This suggestion does not account for certain difficult-to-predict factors that may affect the independent IR residency match.

HE4: really a novel biomarker for ovarian cancer?.

Ovarian cancer forms 4% of all cancers and approximately 23% of all gynecological cancers in women and is responsible for the 47% of deaths related to cancers of the genital tract of women. Tumor markers are the biochemical substances which can be detected in the presence of tumors. Generally they are either the products of tumoral tissues or secreted from the normal cells which are in the inter- action with tumoral ones. The present authors attempted to determine the efficacy of the tumor marker CA- 125 and HE4 to differentiate the malign cases from the benign adnexal masses. A total of 76 patients with the appropriate criteria were included in the study. They were divided into three groups; healthy control group (n=3 1), ones with benign masses (n=23), and ones with malign ovarian masses (n=22). In the study, when the cut-off values were accepted as 55I U/ml for CA-125 and 150 pM for HE4 in differentiation of benign and malign groups, the sensitivity was found as 59.09%, specificity 91.3%, PPV 86.67% and NPV 70% LR = +6.8. This combination gives one false positive result to every five positive cases which were detected as high. With the combination of CA-125 and HE4, the value of sensitivity was found decreased as expected, although the value of the specificity increased.

Binaural squelch and head shadow effects in children with unilateral cochlear implants and contralateral hearing aids.

The aim of this study was to investigate the amount of binaural squelch effect (BSE) and head shadow effect (HSE) in children who use unilateral cochlear implants (CI) and contralateral hearing aids (HA). The study group consisted of 19 CI recipient children who consistently wore a contralateral HA. Speech sounds were used to evaluate speech perception performance in noise. Testing was performed in three listening conditions: (1) bimodal listening with noise source on HA side; (2) CI only with noise source contralaterally (HA off); (3) CI only with noise source on the CI side. Statistical analysis revealed a significant difference between the three listening conditions and post hoc tests indicated significant differences for all pairwise comparisons (p < 0.001). The average BSE and HSE were 11.8% and 17.1% respectively. The majority of bimodal CI users showed BSE and HSE with significant speech perception improvement in the presence of noise.

Managing incidental findings on abdominal and pelvic CT and MRI, Part 2: white paper of the ACR Incidental Findings Committee II on vascular findings.

This white paper describes vascular incidental findings found on CT and MRI of the abdomen and pelvis. Recommendations for management are included. This represents the second of 4 such papers from the ACR Incidental Findings Committee II, which used a consensus method based on repeated reviews and revisions and a collective review and interpretation of relevant literature. Topics include definitions and recommended management for abdominal aortic, iliac, splenic, renal, and visceral artery aneurysms. Other incidentally discovered aortic conditions, systemic venous anomalies, compression syndromes, abdominal venous thrombosis, and gonadal and pelvic venous conditions are also discussed. A table is provided for reference.

2013 appropriate utilization of cardiovascular imaging: a methodology for the development of joint criteria for the appropriate utilization of cardiovascular imaging by the American College of Cardiology Foundation and American College of Radiology.

The American College of Radiology (ACR) and the American College of Cardiology Foundation (ACCF) have jointly developed a method to define appropriate utilization of cardiovascular imaging. The primary role of this method is to create a series of documents to define the utility of cardiovascular imaging procedures in relation to specific clinical questions, with the aim of defining what, if any, imaging tests are indicated to help to determine diagnosis, treatment, or outcome. The methodology accomplishes this aim through the application of systematic evidence reviews integrated with expert opinion by means of a rigorous Delphi process. By obtaining broad input during the development process from radiologists, cardiologists, primary care physicians, and other stakeholders, these documents are intended to provide practical evidence-based guidance to ordering providers, imaging laboratories, interpreting physicians, patients, and policymakers as to optimal cardiovascular imaging utilization. This document details the history, rationale, and methodology for developing these joint documents for appropriate utilization of cardiovascular imaging.