Prospective multicenter assessment of patient preferences for properties of gadolinium-based contrast media and their potential socioeconomic impact in a screening breast MRI setting.

OBJECTIVE: It is unknown how patients prioritize gadolinium-based contrast media (GBCM) benefits (detection sensitivity) and risks (reactions, gadolinium retention, cost). The purpose of this study is to measure preferences for properties of GBCM in women at intermediate or high risk of breast cancer undergoing annual screening MRI. METHODS: An institutional reviewed board-approved prospective discrete choice conjoint survey was administered to patients at intermediate or high risk for breast cancer undergoing screening MRI at 4 institutions (July 2018-March 2020). Participants were given 15 tasks and asked to choose which of two hypothetical GBCM they would prefer. GBCMs varied by the following attributes: sensitivity for cancer detection (80-95%), intracranial gadolinium retention (1-100 molecules per 100 million administered), severe allergic-like reaction rate (1-19 per 100,000 administrations), mild allergic-like reaction rate (10-1000 per 100,000 administrations), out-of-pocket cost ($25-$100). Attribute levels were based on published values of existing GBCMs. Hierarchical Bayesian analysis was used to derive attribute "importance." Preference shares were determined by simulation. RESULTS: Response (87% [247/284]) and completion (96% [236/247]) rates were excellent. Sensitivity (importance = 44.3%, 95% confidence interval = 42.0-46.7%) was valued more than GBCM-related risks (mild allergic-like reaction risk (19.5%, 17.9-21.1%), severe allergic-like reaction risk (17.0%, 15.8-18.1%), intracranial gadolinium retention (11.6%, 10.5-12.7%), out-of-pocket expense (7.5%, 6.8-8.3%)). Lower income participants placed more importance on cost and less on sensitivity (p < 0.01). A simulator is provided that models GBCM preference shares by GBCM attributes and competition. CONCLUSIONS: Patients at intermediate or high risk for breast cancer undergoing MRI screening prioritize cancer detection over GBCM-related risks, and prioritize reaction risks over gadolinium retention. KEY POINTS: • Among women undergoing annual breast MRI screening, cancer detection sensitivity (attribute "importance," 44.3%) was valued more than GBCM-related risks (mild allergic reaction risk 19.5%, severe allergic reaction risk 17.0%, intracranial gadolinium retention 11.6%, out-of-pocket expense 7.5%). • Prospective four-center patient preference data have been incorporated into a GBCM choice simulator that allows users to input GBCM properties and calculate patient preference shares for competitor GBCMs. • Lower-income women placed more importance on out-of-pocket cost and less importance on cancer detection (p < 0.01) when prioritizing GBCM properties.

An assessment of the functional effects of amphetamine-induced dendritic changes in the nucleus accumbens, medial prefrontal cortex, and hippocampus on different types of learning and memory function.

The present experiments investigated the effects of repeated amphetamine exposure on neural networks mediating different forms of learning and memory. Different components of these networks were assessed using various functional assays. The hypothesis was that abnormal dendritic changes in nucleus accumbens, medial prefrontal cortex, and hippocampus mediated by repeated amphetamine exposure would produce impairments on forms of learning and memory dependent on neural circuits relying on these brain systems, and have little or no effect on other forms of learning not dependent on these networks. Surprisingly, the results showed that many of the dendritic changes normally found in the nucleus accumbens, prefrontal cortex, and hippocampus following repeated amphetamine exposure were reversed back to control levels following extensive multi-domain cognitive training. Learning and memory functions associated with different neural networks also appeared normal except in one case. A neural network that includes, but is not limited to, the basolateral amygdala and nucleus accumbens was dysfunctional in rats repeatedly exposed to amphetamine despite the reversal of the majority of dendritic changes in the nucleus accumbens following cognitive training. Importantly, an increase in spine density that normally occurs in these brain regions following repeated amphetamine exposure remained following extensive cognitive training, particularly in the nucleus accumbens.

Assessment of Sleep, K-Complexes, and Sleep Spindles in a T21 Light-Dark Cycle.

Circadian rhythm misalignment has a deleterious impact on the brain and the body. In rats, exposure to a 21-hour day length impairs hippocampal dependent memory. Sleep, and particularly K-complexes and sleep spindles in the cortex, have been hypothesized to be involved in memory consolidation. Altered K-complexes, sleep spindles, or interaction between the cortex and hippocampus could be a mechanism for the memory consolidation failure but has yet to be assessed in any circadian misalignment paradigm. In the current study, continuous local field potential recordings from five rats were used to assess the changes in aspects of behavior and sleep, including wheel running activity, quiet wakefulness, motionless sleep, slow wave sleep, REM sleep, K-complexes and sleep spindles, in rats exposed to six consecutive days of a T21 light-dark cycle (L9:D12). Except for a temporal redistribution of sleep and activity during the T21, there were no changes in period, or total amount for any aspect of sleep or activity. These data suggest that the memory impairment elicited from 6 days of T21 exposure is likely not due to changes in sleep architecture. It remains possible that hippocampal plasticity is affected by experiencing light when subjective circadian phase is calling for dark. However, if there is a reduction in hippocampal plasticity, changes in sleep appear not to be driving this effect.

Looking beyond the standard version of the Morris water task in the assessment of mouse models of cognitive deficits.

Most studies investigating hippocampal-dependent learning and memory in mouse models of disease use the standard version of the Morris water task (MWT), in which a place is learned over several days. While useful in determining if there are learning and memory deficits, often it is not clear if memory acquisition, consolidation, or retrieval is affected. For rats, we developed a variant of the task in which we added a single-massed training session to a new location after the standard distributed version of the MWT. Using this version of the task, competition between these two spatial representations can then be assessed in a probe trial. We have found in rat models of Alzheimer's disease that this paradigm can detect subtle impairments that are often missed in the standard version of the MWT. To the best of our knowledge, MWT paradigm with a single-massed training session have never been used for mice. We sought to validate this paradigm for the use of assessing mouse models of disease. In the first two experiments, control mice did not have a preference for the new platform location, but instead with extensive training in the massed session displayed a preference for both the old and new locations. In the third experiment, a novel mouse model of Alzheimer's disease was impaired in the standard version of the MWT, but not in the massed training phase of this paradigm. Importantly, these data demonstrate that our paradigm is more informative in characterizing spatial learning and memory in mouse models of disease.

Gender and Radiology Publication Productivity: An Examination of Academic Faculty From Four Health Systems in the United States.

OBJECTIVES: To compare male and female radiology faculty publication productivity metrics at four major academic centers. MATERIALS AND METHODS: All Radiology Department faculty members at four academic medical centers from January 1, 2000, to December 31, 2015, were included. Publication metrics including total number of manuscripts published; h- and m-indices; number of publications where faculty member was listed as first, last, or sole author; whether a woman was listed as one of the first five coauthors; and year of first publication were retrieved from Scopus. Publication metrics were compared between genders using the Wilcoxon signed-rank and χ2 tests. RESULTS: A total of 711 faculty members (519 male, 192 [27%] female members) were identified. Male faculty had a significantly higher number of total publications (median 54 versus 24, P < .0001), publications per year (median 2.9 versus 1.6, P < .0001), and h- (median 17 versus 10, P < .0001) and m-indices (median 0.83 versus 0.60, P < .0001) than female faculty. Male faculty had a significantly higher percentage of single author (median 1% versus 0%, P = .0014) and last author (median 16% versus 11%, P < .0001) publications than female faculty. Female faculty had a significantly higher percentage of first author publications (21% versus 17%, P = .0025) and were significantly more likely to have another woman in their first five coauthor list (70% versus 45%, P < .0001) than male faculty. CONCLUSIONS: Large differences exist between female and male faculty in total publications; h- and m-indices; publications per year; number of first, single, last author papers; and percentage of faculty that have a female coauthor in their top five coauthor lists.

Utilizing a novel tool for the comprehensive assessment of resident operative performance.

PURPOSE: A mechanism for more effective and comprehensive assessment of surgical residents' performance in the operating room (OR) is needed, especially in light of the new requirements issued by the American Board of Surgery. Furthermore, there is an increased awareness that assessments need to be more meaningful by including not only procedure-specific and general technical skills, but also nontechnical skills (NOTECHS), such as teamwork and communication skills. Our aims were to develop a methodology and create a tool that comprehensively assesses residents' operative performance. METHODS: A procedure-specific technical skill assessment for laparoscopic colon resections was created through use of task analysis. Components of previously validated tools were added to broaden the assessment to include general technical skills and NOTECHS. Our instrument was then piloted in the OR to measure face and content validity through an iterative process with faculty evaluators. Once the tool was finalized, postgraduate 3 (PG3) and PG5 residents on a 2-month long rotation were assessed by 1 of 4 colorectal surgeons immediately after completing a case together. Construct validity was measured by evaluating the difference in scores between PG3 and PG5 residents' performance as well as the change in scores over the course of the rotation. RESULTS: Sixty-three assessments were performed. All evaluations were completed within 48 hours of the operation. There was a statistically significant difference between the PG3 and PG5 scores on procedure-specific performance, general technical skills, NOTECHS, and overall performance. Over the course of the rotation, a statistically significant improvement was found in residents' scores on the procedure-specific portion of the assessment but not on the general surgical skills or NOTECHS. CONCLUSION: This is a feasible, valid, and reliable assessment tool for the comprehensive evaluation of resident performance in the OR. We plan to use this tool to assess resident operative skill development and to improve direct resident feedback.

Is the h-index predictive of greater NIH funding success among academic radiologists?

RATIONALE AND OBJECTIVES: Despite rapid adoption of the Hirsch index (h-index) as a measure of academic success, the correlations between the h-index and other metrics of productivity remain poorly understood. The aims of this study were to determine whether h-indices were associated with greater National Institutes of Health (NIH) funding success among academic radiologists. MATERIALS AND METHODS: Using the Scopus database, h-indices were calculated for a random sample of academic radiologists with the rank of professor. Using the NIH tool Research Portfolio Online Reporting Tools Expenditures and Reports, we determined the number, classification, and total years of NIH grant funding as principal investigator for each radiologist. Differences in h-index, sorted by funding status, were determined using Wilcoxon's tests. Associations between h-index and funding status were determined using logistic regression. Significant correlations between h-index and grant metrics were determined using Spearman's ρ. RESULTS: Among 210 professors of radiology, 48 (23%) secured at least one NIH grant. The mean h-index was significantly higher among individuals who secured at least one NIH grant (19.1) compared to those who did not (10.4) (P < .0001). Professors with h-indices < 10 compared to those with h-indices > 10 were significantly less likely to receive NIH funding (odds ratio, 0.07; P = .0321). However, h-indices > 10 were not significantly predictive of greater funding. No significant relationships were observed between h-index and the number of grant awards, years of prior funding, the amounts of grant awards, or grant classification. CONCLUSION: Having obtained at least one NIH grant was associated with a higher h-index, yet multiple or large grants, such as those for program projects, were not predictive of higher h-indices.