A Student Teaching Assistant Program for Diversity, Equity, Inclusion, and Antiracism Curricular Enhancement.

PROBLEM: In the United States, physician bias is exhibited early in medical training and contributes to systemic inequities within the field of medicine. A lack of diversity, equity, inclusion, and antiracism (DEI-AR) content within medical curricula drives critical gaps in knowledge and deficiencies when preparing medical students to serve patients of diverse backgrounds. At the Mayo Clinic Alix School of Medicine (MCASOM), student-led curricular reviews between 2017 to 2018 and 2020 to 2021 revealed opportunities to improve DEI-AR content within preclinical courses. Course directors expressed concern of limited expertise and time to enact effective changes. APPROACH: The MCASOM DEI-AR teaching assistant (TA) program aims to curate a collaborative partnership between course directors and compensated student TAs to facilitate course enhancements responsive to the prior preclinical course review while centering standardized DEI-AR best practices. OUTCOMES: As of January 2024, the program has engaged 14 TAs and partnered with 24 preclinical courses. Postcourse student evaluation responses were collected from 8 courses for 2021 to 2022 (before enhancements) and 2022 to 2023 (after enhancements). Student satisfaction with DEI-AR content is tracked through postcourse evaluations, with preliminary data demonstrating improvement after DEI-AR curricular integration (improvement of mean preenhancement and postenhancement scores of 3.81 to 4.05; t12 = 1.79, P = .21). Qualitative student comments were sorted into general categories of positive, negative, or neutral, showing a 6.25% median increase in positive perception of DEI. NEXT STEPS: Plans for the MCASOM DEI-AR TA program include application of quality improvement strategies to improve program processes and outcomes. Development of a centralized dashboard that integrates course enhancement progress and ongoing feedback from evaluations is anticipated to facilitate this effort. The program additionally aims to develop partnerships with clinical clerkships, which would allow for a more comprehensive enhancement of the overall medical education experience related to DEI-AR.

Mammary and extramammary myofibroblastoma: multimodality imaging features with clinicopathologic correlation, management and outcomes in a series of 23 patients.

OBJECTIVE: The purpose of this study was to describe the imaging appearance, diagnosis, and management of mammary and extramammary myofibroblastoma (MFB) in a series of 23 patients. METHODS AND MATERIALS: Following institutional review board approval, cases were identified by searching for "myofibroblastoma" in radiology reports. Multimodality imaging and pathological features were assessed. RESULTS: 23 cases of myofibroblastoma were identified in 15 males and 8 females. Most cases were in the breast (20/23, 87%), presenting as a palpable mass or discovered incidentally on mammography in females or chest CT in males. Extramammary MFB lesions (3/23, 13%) presented with symptoms related to mass effect. At imaging, MFB most often demonstrated an oval or irregular mass that was hypoechoic or heterogeneously echogenic with variable margins. MRI showed T2 hyperintensity, diffusion restriction, and plateau kinetics. Extramammary MFB appeared as an enhancing mass with variable fat content and T2 intensity. CONCLUSION: Here we describe imaging and clinicopathological features of mammary and extramammary myofibroblastoma. ADVANCES IN KNOWLEDGE: Imaging description of this rare tumor is limited in the literature, and to date this is the largest case series describing the imaging findings.

Digital breast tomosynthesis (DBT)-guided biopsy of calcifications: pearls and pitfalls.

As digital breast tomosynthesis (DBT) is quickly becoming the standard of care in clinical practice, DBT-guided procedures are being more frequently utilized. DBT-guided biopsies of calcifications are efficient and easy to perform. As radiologists seek proficiency in these biopsies, there are some unique features of DBT-guided biopsies that they must consider. In this review, we provide a step-by-step guide on performing DBT-guided biopsies of calcifications, with a focus on pearls and pitfalls for problem solving in difficult biopsy cases.

The Role of Cognitive Bias in Breast Radiology Diagnostic and Judgment Errors.

Cognitive bias is an unavoidable aspect of human decision-making. In breast radiology, these biases contribute to missed or erroneous diagnoses and mistaken judgments. This article introduces breast radiologists to eight cognitive biases commonly encountered in breast radiology: anchoring, availability, commission, confirmation, gambler's fallacy, omission, satisfaction of search, and outcome. In addition to illustrative cases, this article offers suggestions for radiologists to better recognize and counteract these biases at the individual level and at the organizational level.

Assessment of users' acceptability of a mobile-based embodied conversational agent for the prevention and detection of suicidal behaviour.

The use of embodied conversational agents in mental health has increased in the last years. Several studies exist describing the benefits and advantages of this technology as a complement to psychotherapeutic interventions for the prevention and treatment of depression, anxiety, or post-traumatic stress disorder, to name a few. A small number of these works implement capabilities in the virtual agent focused on the detection and prevention of suicidality risks. The work presented in this paper describes the development of an embodied conversational agent used as the main interface in HelPath, a mobile-based application addressed to individuals detected with any of the suicidal behaviours: ideation, planning or attempt. The main objective of HelPath is to continuously collect user's information that, complemented with data from the electronic health record, supports the identification of risks associated with suicidality. Through the virtual agent, the users also receive information and suggestions based on cognitive behaviour therapy that would help them to maintain a healthy condition. The paper also presents the execution of an exploratory pilot to assess the acceptability, perception and adherence of users towards the virtual agent. The obtained results are presented and discussed, and some actions for further improvement of the embodied conversational agent are also identified.

Call For Help! The Importance of Role Delineation in a Standardized Contrast Media Emergency Response Protocol.

With the use of intravenous contrast in medical imaging, radiologists and radiology personnel will inevitably encounter adverse events at their imaging facilities. At our institution, the stress of these emergency scenarios led to disorderly and unsafe responses by the staff. We present a quality improvement project, where our team addressed these unsafe emergency responses. Through explicit role delineation and standardization, we created an effective and efficient emergency response protocol that was replicable throughout our healthcare organization.

Performance Benchmarks for Screening Breast MR Imaging in Community Practice.

Purpose To compare screening magnetic resonance (MR) imaging performance in the Breast Cancer Surveillance Consortium (BCSC) with Breast Imaging Reporting and Data System (BI-RADS) benchmarks. Materials and Methods This study was approved by the institutional review board and compliant with HIPAA and included BCSC screening MR examinations collected between 2005 and 2013 from 5343 women (8387 MR examinations) linked to regional Surveillance, Epidemiology, and End Results program registries, state tumor registries, and pathologic information databases that identified breast cancer cases and tumor characteristics. Clinical, demographic, and imaging characteristics were assessed. Performance measures were calculated according to BI-RADS fifth edition and included cancer detection rate (CDR), positive predictive value of biopsy recommendation (PPV2), sensitivity, and specificity. Results The median patient age was 52 years; 52% of MR examinations were performed in women with a first-degree family history of breast cancer, 46% in women with a personal history of breast cancer, and 15% in women with both risk factors. Screening MR imaging depicted 146 cancers, and 35 interval cancers were identified (181 total-54 in situ, 125 invasive, and two status unknown). The CDR was 17 per 1000 screening examinations (95% confidence interval [CI]: 15, 20 per 1000 screening examinations; BI-RADS benchmark, 20-30 per 1000 screening examinations). PPV2 was 19% (95% CI: 16%, 22%; benchmark, 15%). Sensitivity was 81% (95% CI: 75%, 86%; benchmark, >80%), and specificity was 83% (95% CI: 82%, 84%; benchmark, 85%-90%). The median tumor size of invasive cancers was 10 mm; 88% were node negative. Conclusion The interpretative performance of screening MR imaging in the BCSC meets most BI-RADS benchmarks and approaches benchmark levels for remaining measures. Clinical practice performance data can inform ongoing benchmark development and help identify areas for quality improvement. © RSNA, 2017.

Prevalencia de marcadores de infecciones transmisibles y su relación con variables demográficas en un banco de sangre de Antioquia-Colombia, 2010-2013 / Prevalence of markers of transmissible infections in a blood bank of Antioquia, Colombia, 2010-2013

Introducción: las infecciones transmisibles por vía transfusional presentan divergencias en su magnitud y factores asociados, en correspondencia con el perfil epidemiológico de la población de referencia de cada banco de sangre. Objetivo: establecer la prevalencia de marcadores de infecciones transmisibles por vía transfusional y sus factores demográficos relacionados en un banco de sangre de Antioquia, en el periodo 2010-2013. Métodos: estudio transversal en donantes de un banco de sangre de Antioquia en quienes se aplicaron los criterios de inclusión de la resolución 901 de 1996. La fuente de información fue secundaria y los análisis de los marcadores de infecciones y sus factores relacionados se basaron en el cálculo de medidas de resumen, prueba chi cuadrado, razones de prevalencia y evaluación de la confusión por regresión logística binaria. Resultados: se incluyeron 15 461 donantes con edad promedio de 36 años.La prevalencia de positividad para cualquier marcador fue 1,18 %, de infecciones virales 0,15 %, de Treponema pallidum 1,00 % y de T. cruzi del 0,02 %. La prevalencia global de infecciones y de T. pallidum fue estadísticamente mayor en hombres, personas de mayor edad, donantes de reposición y ocupación de "servicios, deportes y recreación" y amas de casa; en el análisis multivariado se demostró que estas asociaciones no presentaron confusión. Conclusión: la prevalencia de infecciones fue muy baja y menor en comparación con investigaciones previas, los subgrupos con una prevalencia estadísticamente mayor fueron los hombres, donantes de reposición y personas de mayor edad; esto permite la orientación de investigaciones y acciones sanitarias posteriores.

Introduction: Transfusion transmissible infections present differences in magnitude and associated factors according to the epidemiological profile of the reference population of each blood bank. Objective: To determine the prevalence of markers of transfusion transmissible infections and associated factors in a Blood Bank Antioquia, 2010-2013. Methods: Cross-Sectional study of prevalence in donors from a blood bank Antioquia in whom inclusion criteria of resolution 901 of 1996 were applied. The source information was secondary and the analyzes were based on the calculation of summary measures, proportions, chi square test, prevalence ratios and evaluation of confusing by binary logistic regression. Results: We included 15 461 donors with a mean age of 36 years. The prevalence of positivity for any marker was 1.18 %, viral infections 0.15 %, Treponema pallidum 1.00 % and T. cruzi 0.02 %. The overall prevalence and of T. pallidum infection was statistically higher in men, elderly, replacement donors and persons with occupation of "services, sports and recreation" and housewives, in the multivariate analysis it showed that these associations did not present confusion. Conclusion: The prevalence of infection was lower compared to previous researches; the subgroups with statistically higher prevalence were men, replacement donors and elderly, this constitute a finding of interest for targeting investigations and health actions.

The use of RelocaTE and unassembled short reads to produce high-resolution snapshots of transposable element generated diversity in rice.

Transposable elements (TEs) are dynamic components of genomes that often vary in copy number among members of the same species. With the advent of next-generation sequencing TE insertion-site polymorphism can be examined at an unprecedented level of detail when combined with easy-to-use bioinformatics software. Here we report a new tool, RelocaTE, that rapidly identifies specific TE insertions that are either polymorphic or shared between a reference and unassembled next-generation sequencing reads. Furthermore, a novel companion tool, CharacTErizer, exploits the depth of coverage to classify genotypes of nonreference insertions as homozygous, heterozygous or, when analyzing an active TE family, as rare somatic insertion or excision events. It does this by comparing the numbers of RelocaTE aligned reads to reads that map to the same genomic position without the TE. Although RelocaTE and CharacTErizer can be used for any TE, they were developed to analyze the very active mPing element which is undergoing massive amplification in specific strains of Oryza sativa (rice). Three individuals of one of these strains, A123, were resequenced and analyzed for mPing insertion site polymorphisms. The majority of mPing insertions found (~97%) are not present in the reference, and two siblings from a self-crossed of this strain were found to share only ~90% of their insertions. Private insertions are primarily heterozygous but include both homozygous and predicted somatic insertions. The reliability of the predicted genotypes was validated by polymerase chain reaction.

MicroRNAs miR-21a and miR-93 are down regulated in peripheral blood mononuclear cells (PBMCs) from patients with type 1 diabetes.

INTRODUCTION: It is well established that type 1 diabetes (T1D) is an autoimmune disease. Controversial data exists regarding the differential control of the immune system in T1D patients compared to unaffected individuals. MicroRNAs (miRNAs) are involved in the control of gene expression (by negative regulation of gene expression at post-transcriptional level, by mediating translational repression or degradation of the mRNA targets). Their potential role in T cell activation and autoimmunity is controversial. AIM: We investigated the expression profile of miR-21a and miR-93 in PMC samples of 20 T1D patients and 20 healthy controls by means of qPCR in different glucose concentrations (basal, 11 nM and 25 mM), and we analyzed the possible relationship of this expression pattern with autoimmunity. RESULTS: MiR-21a was significantly underexpressed in T1D samples (media values expression 0.23 ± 0.05, p < 0.01) compared to controls (values less than 1 indicate a decrease in gene expression). When the PMCs were incubated with glucose 11 mM and 25 mM, miR-21a expression decreased in controls and increased in T1D samples (0.506 ± 0.05, p < 0.04). MiR-93 was underexpressed in T1D patients (0.331 ± 0.05, p < 0.02) compared to control samples. However, when the PBMCs were incubated with glucose, no changes were observed. No association with autoimmunity was observed. CONCLUSION: We demonstrated that miRNAs have a differential expression in PBMCs from T1D patients compared to controls, suggesting that these miRNAs or others could be involved in T cell regulation.

High glucose concentration in T1D patients modulates apoptotic protein expression: down regulation of BAX and FAS and up regulation of XIAP.

UNLABELLED: Type 1 diabetes mellitus (T1D) is an autoimmune disease characterized by a progressive destruction of pancreatic ß cells. It has been reported that patients with autoimmune diseases exhibit decreased expression of caspase 3 and other pro-apoptotic markers in peripheral blood mononuclear cells (PBMC). AIM: To estimate the expression of apoptosis markers in PBMC from T1D patients cultured with high glucose concentration. RESULTS: At 11 mM of glucose, the pro-apoptotic gene fas showed a 7-fold decreased expression in the T1D group compared to controls, while bax showed a 50-fold decreased expression (medians 0.14 and 0.02, respectively, considering patients as 1). At 44 mM of glucose, there is a decreased expression of the same genes, but less abrupt (medians 0.75 and 0.47). Only the anti-apoptotic gene xiap showed a 2-fold increased expression at 11 mM of glucose (median 2.3). Regarding the clinical history, no relationships were observed with age of diagnosis, ketoacidosis, glucose at debut or GAD-65 and IA-2 titles. CONCLUSION: We can conclude that the apoptotic mechanisms in PBMC of T1D patients under high glucose conditions are altered, and this is proved by the decreased expression of the pro-apoptotic genes fas and bax and by the increased expression of the anti-apoptotic gene xiap.