Reticulate evolution: Detection and utility in the phylogenomics era.

Phylogenomics has enriched our understanding that the Tree of Life can have network-like or reticulate structures among some taxa and genes. Two non-vertical modes of evolution - hybridization/introgression and horizontal gene transfer - deviate from a strictly bifurcating tree model, causing non-treelike patterns. However, these reticulate processes can produce similar patterns to incomplete lineage sorting or recombination, potentially leading to ambiguity. Here, we present a brief overview of a phylogenomic workflow for inferring organismal histories and compare methods for distinguishing modes of reticulate evolution. We discuss how the timing of coalescent events can help disentangle introgression from incomplete lineage sorting and how horizontal gene transfer events can help determine the relative timing of speciation events. In doing so, we identify pitfalls of certain methods and discuss how to extend their utility across the Tree of Life. Workflows, methods, and future directions discussed herein underscore the need to embrace reticulate evolutionary patterns for understanding the timing and rates of evolutionary events, providing a clearer view of life's history.

Groin Complications Among Obese Patients Undergoing Vascular Procedures.

OBJECTIVES: Groin incision wound complications (WC) are common among vascular surgery patients. Obesity is a known risk factor, but there is no consensus on the best way to prevent WC in obese patients after vascular procedures. The objective of this study was to identify risk factors for WC and strategies to prevent these complications specifically in obese patients. METHODS: All patients who had longitudinal groin incisions at a single institution from 2021-2022 were included. The medical records were reviewed and all groin-related WC were identified. WC were stratified into major and minor WC where major WC were those requiring re-operation or hospital re-admission. Patients were stratified into obese (BMI>30kg/m2) and non-obese cohorts. RESULTS: A total of 238 groin incisions were included. There were 46 (19.3%) obese and 192(80.7%) non-obese patients. 156 (65.5%) were closed with nylon, 49 (20.6%) were closed in a subcuticular fashion, and 32 (13.4%) were closed with staples. There were 45 (18.9%) WC; 15 (33.3%) major and 30 (66.7 %) minor. Obesity was associated with a higher WC rate (39.1% vs 14.1%, p<0.001), which was driven by minor WC (32.6% vs 7.8%, p<0.001) rather than major WC (6.5% vs 5.7%, p=0.873). On multivariable analysis, obesity remained a predictor for overall (OR 4.953, p<0.001) and minor WC (OR 7.389, p<0.001). Additionally, female sex was associated with a higher rate of WC on unadjusted (27.6% vs 12.8%, p=0.016) and adjusted analysis (OR 2.411, p=0.014). Among obese patients, subcuticular closure was associated with higher rates of minor complications (OR 8.454, p=0.044). Obese patients with major complications less frequently had close follow-up including rehab disposition, discharge with visiting nurse, or frequent office wound checks than those with minor complications (33.33% vs 86.67%, p=0.043). CONCLUSIONS: Groin WC are more common in obese and female patients. Among obese patients, this difference is driven primarily by minor WC. Avoiding a subcuticular skin closure may reduce the risk of minor WC in obese patients. In addition, close postoperative follow up using rehab, visiting nurse services, and frequent office wound checks may prevent minor complications from escalating to major complications.

Commercial Insurance Coverage Criteria for Autologous Chondrocyte Implantation Poorly Reflect Current Research.

OBJECTIVE: The aim of this study is to both quantify and qualify the way insurance companies justify their coverage policies for autologous chondrocyte implantation (ACI) and determine whether these policies align with recent research on the subject. DESIGN: The top 11 national commercial health insurance payers for ACI were identified. Coverage policy documents were recovered for 8 payers. These documents were examined, and the type of reference and the level of evidence (LOE) were recorded for each applicable reference. Specific coverage criteria for each individual payer were then extracted and assessed for similarities among commercial payers. Finally, all references cited by each payer were examined to determine whether they mentioned the specific payer criteria. RESULTS: This study found that the majority of cited references were primary journal articles (86, 58.1%) and that only 30 (20.2%) references were level I or level II evidence. This study also found significant homogeneity among payer coverage criteria. Cited sources inconsistently mentioned specific payer coverage criteria. In addition, payer criteria tended to be poorly supported by current evidence on ACI. CONCLUSIONS: This study demonstrates that commercial insurance payers' coverage policies for ACI poorly cite references, cite a majority of references with low LOE, and cite references which infrequently mention their specific coverage criteria. In addition, payer coverage policies have a high degree of homogeneity and many of their specific criteria are poorly supported by current research on ACI.

Proteogenomic analysis integrated with electronic health records data reveals disease-associated variants in Black Americans.

BACKGROUND: Most genome wide association studies (GWAS) of plasma proteomics have focused on White individuals of European ancestry, limiting biological insight from other ancestry enriched protein quantitative loci (pQTL). METHODS: We conducted a discovery GWAS of ~3,000 plasma proteins measured by the antibody based Olink platform in 1,054 Black adults from the Jackson Heart Study (JHS), and validated our findings in the Multi-Ethnic Study of Atherosclerosis (MESA). The genetic architecture of identified pQTLs were further explored through fine mapping and admixture association analysis. Finally, using our pQTL findings, we performed a phenome wide association study (PheWAS) across two large multi-ethnic electronic health record (EHR) systems in All of Us and BioMe. RESULTS: We identified 1002 pQTLs for 925 proteins. Fine mapping and admixture analyses suggested allelic heterogeneity of the plasma proteome across diverse populations. We identified associations for variants enriched in African ancestry, many in diseases that lack precise biomarkers, including cis-pQTLs for Cathepsin L (CTSL) and Siglec-9 that were linked with sarcoidosis and non-Hodgkin's lymphoma, respectively. We found concordant associations across clinical diagnoses and laboratory measurements, elucidating disease pathways, including a cis-pQTL associated with circulating CD58, white blood cell count, and multiple sclerosis. CONCLUSIONS: Our findings emphasize the value of leveraging diverse populations to enhance biological insights from proteomics GWAS, and we have made this resource readily available as an interactive web portal.

A taxon-rich and genome-scale phylogeny of Opisthokonta.

Ancient divergences within Opisthokonta-a major lineage that includes organisms in the kingdoms Animalia, Fungi, and their unicellular relatives-remain contentious. To assess progress toward a genome-scale Opisthokonta phylogeny, we conducted the most taxon rich phylogenomic analysis using sets of genes inferred with different orthology inference methods and established the geological timeline of Opisthokonta diversification. We also conducted sensitivity analysis by subsampling genes or taxa from the full data matrix based on filtering criteria previously shown to improve phylogenomic inference. We found that approximately 85% of internal branches were congruent across data matrices and the approaches used. Notably, the use of different orthology inference methods was a substantial contributor to the observed incongruence: analyses using the same set of orthologs showed high congruence of 97% to 98%, whereas different sets of orthologs resulted in somewhat lower congruence (87% to 91%). Examination of unicellular Holozoa relationships suggests that the instability observed across varying gene sets may stem from weak phylogenetic signals. Our results provide a comprehensive Opisthokonta phylogenomic framework that will be useful for illuminating ancient evolutionary episodes concerning the origin and diversification of the 2 major eukaryotic kingdoms and emphasize the importance of investigating effects of orthology inference on phylogenetic analyses to resolve ancient divergences.

Exploratory Factor Analysis of a Patient-Facing PCBH Adherence Measure: The PPAQ-Patient.

Model adherence indicates the degree to which a program or intervention is delivered as intended. In integrated primary care, where mental health services are embedded into primary care clinics, appraisal of model adherence provides insight into whether these services align with key features of this unique practice environment (e.g., brief, interdisciplinary care). To date, such evaluations have emphasized system and provider factors. This study is a preliminary evaluation of whether a novel patient-facing measure, the Primary Care Behavioral Health Provider Adherence Questionnaire-Patient Version (PPAQ-Patient), can provide insight into adherence to the Primary Care Behavioral Health (PCBH) model of integrated primary care. Survey data were collected from 281 veterans who received PCBH care. Exploratory factor analyses evaluated the data structure. Results suggest that 19 items spanning three temporally-referenced subscales may feasibly capture patient perspectives on PCBH adherence at various stages of treatment. Future work is needed to refine the measure.

Temperature-dependent predation predicts a more reptilian future.

Diversity increases toward the tropics, but the strength of this pattern diverges with thermoregulatory strategy. Synthesizing over 30,000 species distributions, we quantified patterns of richness in terrestrial vertebrates, and present evidence for a latitudinal gradient of community composition. We observe a two orders of magnitude shift in comparative diversity with temperature, from endothermic mammal and avian dominance near the poles, toward ectothermic reptile and amphibian majority in the tropics. Next, we provide mechanistic support for a corresponding latitudinal gradient of predatory interactions. Using automated video tracking in >4500 trials, we show that differences in thermal sensitivity of locomotion in endothermic predators and ectothermic prey favors endotherms in colder environments and yields theoretically predicted foraging outcomes across thermal conditions, including the number of strikes, the distance traveled, and the time to capture prey. We also present evidence that endotherms use thermal cues to anticipate prey behavior, modulating the impact of temperature. Finally, we integrate theory and data to forecast future patterns of diversity, revealing that as the world get warmer, it will become increasingly reptilian. Overall, our results point toward a broad reorganization of vertebrate diversity with latitude, elevation, and temperature: from endotherm dominance in cold systems toward ectotherm dominance in warm.

Diverse signatures of convergent evolution in cactus-associated yeasts.

Many distantly related organisms have convergently evolved traits and lifestyles that enable them to live in similar ecological environments. However, the extent of phenotypic convergence evolving through the same or distinct genetic trajectories remains an open question. Here, we leverage a comprehensive dataset of genomic and phenotypic data from 1,049 yeast species in the subphylum Saccharomycotina (Kingdom Fungi, Phylum Ascomycota) to explore signatures of convergent evolution in cactophilic yeasts, ecological specialists associated with cacti. We inferred that the ecological association of yeasts with cacti arose independently approximately 17 times. Using a machine learning-based approach, we further found that cactophily can be predicted with 76% accuracy from both functional genomic and phenotypic data. The most informative feature for predicting cactophily was thermotolerance, which we found to be likely associated with altered evolutionary rates of genes impacting the cell envelope in several cactophilic lineages. We also identified horizontal gene transfer and duplication events of plant cell wall-degrading enzymes in distantly related cactophilic clades, suggesting that putatively adaptive traits evolved independently through disparate molecular mechanisms. Notably, we found that multiple cactophilic species and their close relatives have been reported as emerging human opportunistic pathogens, suggesting that the cactophilic lifestyle-and perhaps more generally lifestyles favoring thermotolerance-might preadapt yeasts to cause human disease. This work underscores the potential of a multifaceted approach involving high-throughput genomic and phenotypic data to shed light onto ecological adaptation and highlights how convergent evolution to wild environments could facilitate the transition to human pathogenicity.

Evolutionary origin and population diversity of a cryptic hybrid pathogen.

Cryptic fungal pathogens pose disease management challenges due to their morphological resemblance to known pathogens. Here, we investigated the genomes and phenotypes of 53 globally distributed isolates of Aspergillus section Nidulantes fungi and found 30 clinical isolates-including four isolated from COVID-19 patients-were A. latus, a cryptic pathogen that originated via allodiploid hybridization. Notably, all A. latus isolates were misidentified. A. latus hybrids likely originated via a single hybridization event during the Miocene and harbor substantial genetic diversity. Transcriptome profiling of a clinical isolate revealed that both parental subgenomes are actively expressed and respond to environmental stimuli. Characterizing infection-relevant traits-such as drug resistance and growth under oxidative stress-revealed distinct phenotypic profiles among A. latus hybrids compared to parental and closely related species. Moreover, we identified four features that could aid A. latus taxonomic identification. Together, these findings deepen our understanding of the origin of cryptic pathogens.

Preoperative Mental Health Disorders Affect Opioid Consumption and Perioperative Complications After Total Shoulder Arthroplasty.

BACKGROUND: Limited evidence exists regarding the influence of mental health disorders (MHDs) on opioid use and complications after total shoulder arthroplasty (TSA). We aimed to identify the prevalence of common MHDs among patients undergoing anatomic TSA (aTSA) and reverse TSA (rTSA). MATERIALS AND METHODS: The Premier Healthcare Database was queried for patients undergoing primary aTSA and rTSA from 2016 to 2020. International Classification of Diseases, Tenth Revision, diagnosis codes were used to identify MHDs. Primary outcomes included the prevalence of MHDs, perioperative opioid consumption, and 90-day risk of postoperative complications, revision, and readmission. Bivariate and multivariate regression analyses were performed to assess 90-day risk of primary endpoints while controlling for potential confounders. Statistical significance was defined as P<.05. RESULTS: From 2016 to 2020, 49,997 of 144,725 (34.55%) patients undergoing primary TSA had at least one diagnosed MHD. The most prevalent were depression (17.03%), anxiety (16.75%), and substance use disorder (10.20%). Patients with a MHD had higher mean hospital costs ($75,984±$43,129 vs $73,316±$39,046, P<.0001), longer mean length of stay (1.95±2.25 days vs 1.61±1.51 days, P<.0001), and higher mean total postoperative opioid use (72.00±231.55 morphine milligram equivalents [MMEs] vs 59.32±127.31 MMEs, P<.0001). Periprosthetic fractures (odds ratio, 1.20; P=.041), dislocation (odds ratio, 1.12; P=.042), and 90-day readmission rates (odds ratio, 1.26; P<.001) were significantly higher among patients with a MHD. CONCLUSION: This study found that MHDs are associated with significantly increased perioperative opioid consumption, medical and surgical complication rates, and risk of readmission after TSA. Recognition and optimization of MHDs is critical to minimizing complications and opioid consumption after TSA. [Orthopedics. 202x;4x(x):xx-xx.].

Studies with Direct Industry Affiliation are More Likely to Report Positive Results in Randomized Controlled Trials for Platelet-Rich Plasma Use in Rotator Cuff Pathology: A Systematic Review.

PURPOSE: To perform a systematic review to evaluate the effect of industry affiliation on the outcomes of randomized controlled trials (RCTs) for platelet-rich plasma (PRP) injections in rotator cuff tears. METHODS: PubMed, SPORTdiscus, and Scopus databases were searched from 2010 to the present for terms "rotator cuff" and "platelet-rich plasma." Inclusion criteria were RCTs comparing PRP to controls for treatment of rotator cuff tears and exclusion criteria were systematic reviews, meta-analyses, case reports, cohort studies, basic science studies, other level 3 and below studies, and studies not in English. Degree of industry affiliation was categorized into three groups: direct, indirect, and not affiliated. Direct affiliation required the study or its authors to receive financial support from the company manufacturing the devices used in the study to prepare or administer PRP. Indirect affiliation required financial association with a different company that produces or administers PRP than the one used in the study. Studies were classified as favorable if study outcomes achieved significance (p < 0.05) of PRP over the control, or analogous if there was no statistical significance between PRP and control. Data was analyzed using chi-squared and fisher's exact tests. RESULTS: Of the 47 studies selected for analysis, 8 (17.0%) had no direct industry affiliation, 9 (19.1%) indirect affiliation and 30 (63.8%) no industry affiliation. 22 (46.8%) studies reported favorable results with PRP compared to the control and 25 (53.2%) showed analogous results between PRP and control. Degree of industry affiliation was significantly associated with increased likelihood of reporting favorable study outcomes (p = 0.041). Directly affiliated studies had a significantly increased likelihood of reporting favorable results (p = 0.024) compared to indirectly affiliated. CONCLUSIONS: Studies that used PRP produced by companies that directly fund the study or were financially affiliated with the authors were significantly more likely to report favorable results. LEVEL OF EVIDENCE: Systematic review of Level I and II studies.

The Literature that Commercial Insurance Payers Use to Substantiate Knee Osteochondral Allograft Policies Are of a Low Level of Evidence.

OBJECTIVE: The purpose of this study is to analyze how the largest insurance companies support their medical necessity policies regarding osteochondral allograft transplantation (OCA) and to determine whether the literature they cite in their policies is of a high level of evidence (LOE). DESIGN: The 10 largest national health insurance companies were identified. Each payer was contacted via phone or email to obtain their coverage policy regarding OCA. For each policy, the medical necessity criteria were recorded, and all cited references were screened. For all references applicable to OCA, the LOE was recorded, and each reference was screened to determine whether they mentioned the specific criteria reported in the policies. RESULTS: The medical policies for 6 of the 10 national health insurance companies were identified. These 6 policies cited a collective total of 102 applicable references. Most of these studies were an LOE of IV (n = 58, 56.9%) and an LOE of V (n = 18, 17.6%). There were similarities amongst the medical necessity criteria between different commercial payers; however, most criteria were poorly supported by the cited literature. CONCLUSIONS: Our results demonstrate that commercial insurance companies utilize studies that are of a low LOE when justifying their medical necessity criteria. Moreover, these cited studies infrequently support or mention the commercial payers' criteria. Future studies should continue to explore how well-supported insurance policies are with the goal of potentially increasing access and authorization for well-supported treatment modalities.

Assessment of an Artificial Intelligence Tool for Estimating Left Ventricular Ejection Fraction in Echocardiograms from Apical and Parasternal Long-Axis Views.

This work aims to evaluate the performance of a new artificial intelligence tool (ExoAI) to compute the left ventricular ejection fraction (LVEF) in echocardiograms of the apical and parasternal long axis (PLAX) views. We retrospectively gathered echocardiograms from 441 individual patients (70% male, age: 67.3 ± 15.3, weight: 87.7 ± 25.4, BMI: 29.5 ± 7.4) and computed the ejection fraction in each echocardiogram using the ExoAI algorithm. We compared its performance against the ejection fraction from the clinical report. ExoAI achieved a root mean squared error of 7.58% in A2C, 7.45% in A4C, and 7.29% in PLAX, and correlations of 0.79, 0.75, and 0.89, respectively. As for the detection of low EF values (EF < 50%), ExoAI achieved an accuracy of 83% in A2C, 80% in A4C, and 91% in PLAX. Our results suggest that ExoAI effectively estimates the LVEF and it is an effective tool for estimating abnormal ejection fraction values (EF < 50%). Importantly, the PLAX view allows for the estimation of the ejection fraction when it is not feasible to acquire apical views (e.g., in ICU settings where it is not possible to move the patient to obtain an apical scan).

Viability of shear wave elastography to predict mechanical/ultimate failure in the anterolateral and medial collateral ligaments of the knee.

The purpose of this study was (1) to determine the utility of shear wave elastography as a predictor for the mechanical failure of superficial knee ligaments and (2) to determine the viability of shear wave elastography to assess injury risk potential. Our hypothesis was that shear wave elastography measurements of the anterolateral ligament and medial collateral ligament would directly correlate with the material properties and the mechanical failure of the ligament, serving as a prognostic measurement for injury risk. 8 cadaveric specimens were acquired, and tissue stiffness for the anterolateral ligament and medial collateral ligament were evaluated with shear wave elastography. The anterolateral ligament and medial collateral ligament were dissected and isolated for unilateral mechanical failure testing. Ultimate failure testing was performed at 100 % strain per second after 50 cycles of 3 % strain viscoelastic conditioning. Each specimen was assessed for load, displacement, and surface strain throughout failure testing. Rate of force, rate of strain development, and Young's modulus were calculated from these variables. Shear wave elastography stiffness for the anterolateral ligament correlated with mean longitudinal anterolateral ligament strain at failure (R2 = 0.853; P<0.05). Medial collateral ligament shear wave elastography calculated modulus was significantly greater than the anterolateral ligament shear wave elastography calculated modulus. Shear wave elastography currently offers limited reliability in the prediction of mechanical performance of superficial knee ligaments. The utility of shear wave elastography assessment for injury risk potential remains undetermined.

Role of NEK2 in tumorigenesis and tumor progression.

Never in mitosis A (NIMA)-related kinase 2 (NEK2) is a serine/threonine kinase found in the nucleus and cytoplasm throughout the cell cycle. NEK2 is overexpressed in many cancers and is a biomarker of poor prognosis. Factors contributing to NEK2 elevation in cancer cells include oncogenic transcription factors, decreased ubiquitination, DNA methylation, and the circular RNA (circRNA)/long noncoding RNA (lncRNA)-miRNA axis. NEK2 overexpression produces chromosomal instability and aneuploidy, thereby enhancing cancer progression and suppressing antitumor immunity, which highlights the prominence of NEK2 in tumorigenesis and tumor progression. Small-molecule inhibitors targeting NEK2 have demonstrated promising therapeutic potential in vitro and in vivo across various cancer types. This review outlines the regulatory mechanisms of NEK2 expression, emphasizes its functional roles in cancer initiation and progression, and highlights the anticancer properties of NEK2 inhibitors.

Engineering acyclovir-induced RNA nanodevices for reversible and tunable control of aptamer function.

Small molecule-regulated RNA devices have the potential to modulate diverse aspects of cellular function, but the small molecules used to date have potential toxicities limiting their use in cells. Here we describe a method for creating drug-regulated RNA nanodevices (RNs) using acyclovir, a biologically compatible small molecule with minimal toxicity. Our modular approach involves a scaffold comprising a central F30 three-way junction, an integrated acyclovir aptamer on the input arm, and a variable effector-binding aptamer on the output arm. This design allows for the rapid engineering of acyclovir-regulated RNs, facilitating temporal, tunable, and reversible control of intracellular aptamers. We demonstrate the control of the Broccoli aptamer and the iron-responsive element (IRE) by acyclovir. Regulating the IRE with acyclovir enables precise control over iron-regulatory protein (IRP) sequestration, consequently promoting the inhibition of ferroptosis. Overall, the method described here provides a platform for transforming aptamers into acyclovir-controllable antagonists against physiologic target proteins.

3D printed heterogeneous paediatric head and adult thorax phantoms for linear accelerator radiotherapy quality assurance: from fabrication to treatment delivery.

Objective. This study aims to design and fabricate a 3D printed heterogeneous paediatric head phantom and to customize a thorax phantom for radiotherapy dosimetry.Approach. This study designed, fabricated, and tested 3D printed radiotherapy phantoms that can simulate soft tissue, lung, brain, and bone. Various polymers were considered in designing the phantoms. Polylactic acid+, nylon, and plaster were used in simulating different tissue equivalence. Dimensional accuracy, and CT number were investigated. The phantoms were subjected to a complete radiotherapy clinical workflow. Several treatment plans were delivered in both the head and the thorax phantom from a simple single 6 MV beam, parallel opposed beams, and five-field intensity modulated radiotherapy (IMRT) beams. Dose measurements using an ionization chamber and radiochromic films were compared with the calculated doses of the Varian Eclipse treatment planning system (TPS).Main results. The fabricated heterogeneous phantoms represent paediatric human head and adult thorax based on its radiation attenuation and anatomy. The measured CT number ranges are within -786.23 ± 10.55, 0.98 ± 3.86, 129.51 ± 12.83, and 651.14 ± 47.76 HU for lung, water/brain, soft tissue, and bone, respectively. It has a good radiological imaging visual similarity relative to a real human head and thorax depicting soft tissue, lung, bone, and brain. The accumulated dose readings for both conformal radiotherapy and IMRT match with the TPS calculated dose within ±2% and ±4% for head and thorax phantom, respectively. The mean pass rate for all the plans delivered are above 90% for gamma analysis criterion of 3%/3 mm.Significance and conclusion. The fabricated heterogeneous paediatric head and thorax phantoms are useful in Linac end-to-end radiotherapy quality assurance based on its CT image and measured radiation dose. The manufacturing and dosimetry workflow of this study can be utilized by other institutions for dosimetry and trainings.

Automated Measurement of Cerebral Hemorrhagic Contusions and Outcomes After Traumatic Brain Injury in the TRACK-TBI Study.

Importance: Because withdrawal of life-sustaining therapy based on perceived poor prognosis is the most common cause of death after moderate or severe traumatic brain injury (TBI), the accuracy of clinical prognoses is directly associated with mortality. Although the location of brain injury is known to be important for determining recovery potential after TBI, the best available prognostic models, such as the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) score, do not currently incorporate brain injury location. Objective: To test whether automated measurement of cerebral hemorrhagic contusion size and location is associated with improved prognostic performance of the IMPACT score. Design, Setting, and Participants: This prognostic cohort study was performed in 18 US level 1 trauma centers between February 26, 2014, and August 8, 2018. Adult participants aged 17 years or older from the US-based Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study with moderate or severe TBI (Glasgow Coma Scale score 3-12) and contusions detected on brain computed tomography (CT) scans were included. The data analysis was performed between January 2023 and February 2024. Exposures: Labeled contusions detected on CT scans using Brain Lesion Analysis and Segmentation Tool for Computed Tomography (BLAST-CT), a validated artificial intelligence algorithm. Main Outcome and Measure: The primary outcome was a Glasgow Outcome Scale-Extended (GOSE) score of 4 or less at 6 months after injury. Whether frontal or temporal lobe contusion volumes improved the performance of the IMPACT score was tested using logistic regression and area under the receiver operating characteristic curve comparisons. Sparse canonical correlation analysis was used to generate a disability heat map to visualize the strongest brainwide associations with outcomes. Results: The cohort included 291 patients with moderate or severe TBI and contusions (mean [SD] age, 42 [18] years; 221 [76%] male; median [IQR] emergency department arrival Glasgow Coma Scale score, 5 [3-10]). Only temporal contusion volumes improved the discrimination of the IMPACT score (area under the receiver operating characteristic curve, 0.86 vs 0.84; P = .03). The data-derived disability heat map of contusion locations showed that the strongest association with unfavorable outcomes was within the bilateral temporal and medial frontal lobes. Conclusions and Relevance: These findings suggest that CT-based automated contusion measurement may be an immediately translatable strategy for improving TBI prognostic models.

Training Psychiatrist-Scientists-Excellence on Both Sides of the Hyphen.

This Viewpoint discusses why it is important for psychiatry residency programs to continue to prioritize the training of psychiatrist-scientists.