Treatment response assessment of acute pyelonephritis: A multi-reader DWI-based MRI approach.

PURPOSE: To evaluate the diagnostic accuracy of a structured reporting score (SRS) in treatment response assessment for acute pyelonephritis (APN) using a diffusion-weighted imaging (DWI) -based MRI approach. Additionally, we explored the influence of reader experience on the interpretation of SRS and DWI, including lesion conspicuity and measurements of Apparent Diffusion Coefficient (ADC) maps. METHODS: Follow-up DWI-based MRIs of 36 patients treated for APN between September 2021 and June 2023 were retrospectively reviewed by three readers. Follow-up blood inflammatory markers were used as reference standard. Treatment response was assessed using a structured reporting score (SRS). Each reader assigned a score from 1 to 3 to the "conspicuity" of the residual disease on DWI. Quantitative ADC measurements were compared with the Mann-Whitney U test. Descriptive statistics and Intraclass Correlation Coefficient (ICC) were calculated. RESULTS: The diagnostic accuracy of SRS was 80.6 %, 76.9 %, and 72.2 % for the Reader 1, 2, and 3 respectively. ICC decreased from 0.82 (Reader 1 and 2), to 0.68 when considering all readers. The average conspicuity varied between 2.3 and 2.7. ADC values were significantly higher in complete responders for Reader 1 and 2 (153.5-154.5 vs 107.7-116.2, p < 0.001). The ICC was good (0.89) for Reader 1 and 2 and moderate (0.60) when considering all readers. CONCLUSIONS: Treatment response of pyelonephritis can be accurately assessed by a DWI-based MRI, potentially avoiding unnecessary contrast agent administration and radiation exposure. SRS and DWI analysis showed a good inter-observer agreement but a certain learning curve may be necessary for less expert readers.

What aspects do we overlook in the rehabilitation of patients with inflammatory bowel disease?

In this editorial, we comment on the article by Stafie et al. Inflammatory bowel disease (IBD) constitutes a cluster of chronic and progressive inflammatory disorders affecting the digestive system. IBD can impede an individual's capacity to perform daily activities, hinder work productivity, limit physical capabilities, and negatively impact medical outcomes. Although physical activity and structured exercise programs are becoming increasingly important in many chronic inflammatory diseases, they are not being sufficiently implemented in IBD patients. Effective prevention of future disability and drug dependence in IBD patients requires timely diagnosis and treatment of musculoskeletal problems, including sarcopenia, as well as decreased muscle strength, aerobic capacity, and bone mineral density. To improve treatment outcomes for IBD patients, it is crucial to develop individualized rehabilitation programs tailored to their unique needs. Equally critical is the active participation of pertinent departments in this process. It is imperative to highlight the significance of creating a personalized rehabilitation program with a multidisciplinary approach in IBD management.

Posterior approach to correct for focal plane offsets in lattice light-sheet structured illumination microscopy.

Significance: Lattice light-sheet structured illumination microscopy (latticeSIM) has proven highly effective in producing three-dimensional images with super resolution rapidly and with minimal photobleaching. However, due to the use of two separate objectives, sample-induced aberrations can result in an offset between the planes of excitation and detection, causing artifacts in the reconstructed images. Aim: We introduce a posterior approach to detect and correct the axial offset between the excitation and detection focal planes in latticeSIM and provide a method to minimize artifacts in the reconstructed images. Approach: We utilized the residual phase information within the overlap regions of the laterally shifted structured illumination microscopy information components in frequency space to retrieve the axial offset between the excitation and the detection focal planes in latticeSIM. Results: We validated our technique through simulations and experiments, encompassing a range of samples from fluorescent beads to subcellular structures of adherent cells. We also show that using transfer functions with the same axial offset as the one present during data acquisition results in reconstructed images with minimal artifacts and salvages otherwise unusable data. Conclusion: We envision that our method will be a valuable addition to restore image quality in latticeSIM datasets even for those acquired under non-ideal experimental conditions.

Blood Lipoproteins Shape the Phenotype and Lipid Content of Early Atherosclerotic Lesion Macrophages: A Dual-Structured Mathematical Model.

Macrophages in atherosclerotic lesions exhibit a spectrum of behaviours or phenotypes. The phenotypic distribution of monocyte-derived macrophages (MDMs), its correlation with MDM lipid content, and relation to blood lipoprotein densities are not well understood. Of particular interest is the balance between low density lipoproteins (LDL) and high density lipoproteins (HDL), which carry bad and good cholesterol respectively. To address these issues, we have developed a mathematical model for early atherosclerosis in which the MDM population is structured by phenotype and lipid content. The model admits a simpler, closed subsystem whose analysis shows how lesion composition becomes more pathological as the blood density of LDL increases relative to the HDL capacity. We use asymptotic analysis to derive a power-law relationship between MDM phenotype and lipid content at steady-state. This relationship enables us to understand why, for example, lipid-laden MDMs have a more inflammatory phenotype than lipid-poor MDMs when blood LDL lipid density greatly exceeds HDL capacity. We show further that the MDM phenotype distribution always attains a local maximum, while the lipid content distribution may be unimodal, adopt a quasi-uniform profile or decrease monotonically. Pathological lesions exhibit a local maximum in both the phenotype and lipid content MDM distributions, with the maximum at an inflammatory phenotype and near the lipid content capacity respectively. These results illustrate how macrophage heterogeneity arises in early atherosclerosis and provide a framework for future model validation through comparison with single-cell RNA sequencing data.

Impacts of estuarine habitat degradation on the modeled life history of marine estuarine-dependent and resident fish species.

Shallow coastal and estuarine habitats play an essential role in the life cycles of many fish species, providing spawning, nursery, feeding, and migration areas. However, these ecologically valuable habitats are increasingly threatened by anthropogenic activities, causing substantial changes in both habitat availability and quality. Fish species use these shallow coastal habitats and estuaries during various life stages, leading to their categorization into guilds based on how and when they rely on these areas. This differential functional use of estuaries means that changes to these habitats may affect each guild differently. To understand the impact of estuarine habitat degradation on fish populations, it is therefore necessary to consider the full life cycle of fish and when they rely on these coastal habitats. Here, we use conceptual size-structured population models to study how estuarine habitat degradation affects two functionally different guilds. We use these models to predict how reduced food productivity in the estuary affects the demographic rates and population dynamics of these groups. Specifically, we model estuarine residents, which complete their entire life cycle in estuaries, and marine estuarine-dependent species, which inhabit estuaries during early life before transitioning offshore. We find that total fish biomass for both guilds decreases with decreasing food productivity. However, the density of juveniles of the marine estuarine-dependent guild can, under certain conditions, increase in the estuary. This occurs due to a shift in the population biomass distribution over different life stages and a simultaneous shift in which life stage is most limited by food. At the individual level, somatic growth of juveniles belonging to the estuarine-dependent guild decreased with lower food supply in the estuary, due to increased competition for food. The somatic growth rates of fish belonging to the resident guild were largely unaffected by low food supply, as the total fish density decreased at the same time and therefore the per-capita food availability was similar. These outcomes challenge the assumption that responses to habitat degradation are similar between fish guilds. Our study highlights the need to assess not only fish biomass but also size distributions, survival, and somatic growth rates for a comprehensive understanding of the effects of habitat degradation on fish populations. This understanding is crucial not only for estuary fish communities but also for successful conservation and management of commercially harvested offshore population components.

Near-field electron ptychography using full-field structured illumination.

A new configuration for near-field ptychography using a full-field illumination with a structured electron beam is proposed. A structured electron beam illuminating the entire field of view is scanned over the specimen, and a series of in-line holograms formed in the near-field region below the specimen are collected. The structured beam is generated by a conductive film with random openings, which ensures high stability and coherence of the beam. Observation in the near-field region reduces the beam concentration that occurs in the far-field region, which contributes to accurate recording of the beam intensity with a finite dynamic range of the detectors. The use of full-field illumination prevents the accumulation of errors caused by concatenating the local structures, which is the method used in conventional reconstruction. Since all holograms are obtained from the entire field of view, they have uniform multiplicity in terms of specimen information within the field of view. This contributes to robust and efficient reconstruction for a large field of view. The proposed method was tested using both simulated and experimental holograms. For the simulated holograms, the reconstruction of the specimen transmission function was achieved with an error less than 1/3485 of the wavelength. The method was further validated using experimental holograms obtained from MgO particles. The reconstructed phase transmission function of the specimen was consistent with the specimen structure and was equivalent to a mean inner potential of V on the MgO particle, which is in close agreement with previously reported values.

Automated algorithm for medical data structuring, and segmentation using artificial intelligence within secured environment for dataset creation.

Objective: Routinely collected electronic health records using artificial intelligence (AI)-based systems bring out enormous benefits for patients, healthcare centers, and its industries. Artificial intelligence models can be used to structure a wide variety of unstructured data. Methods: We present a semi-automatic workflow for medical dataset management, including data structuring, research extraction, AI-ground truth creation, and updates. The algorithm creates directories based on keywords in new file names. Results: Our work focuses on organizing computed tomography (CT), magnetic resonance (MR) images, patient clinical data, and segmented annotations. In addition, an AI model is used to generate different initial labels that can be edited manually to create ground truth labels. The manually verified ground truth labels are later included in the structured dataset using an automated algorithm for future research. Conclusion: This is a workflow with an AI model trained on local hospital medical data with output based/adapted to the users and their preferences. The automated algorithms and AI model could be implemented inside a secondary secure environment in the hospital to produce inferences.

"The habit of keeping silent": An exploratory-descriptive qualitative study of the knowledge and attitudes of Kazakhstani gynecologists toward dyspareunia.

BACKGROUND: Dyspareunia (pain during sex) is a common condition that causes physical and emotional stress for many women. This condition can be caused by various factors, including physical, hormonal, inflammatory, viral, neoplastic, psychological, and traumatic events. Anatomical causes include pelvic floor muscular weakness, uterine retroversion, hymenal remnants, and pelvic organ prolapse. The etiology of this condition is complex, causing it to be often overlooked. OBJECTIVES: The main aim of this study was to conduct a qualitative exploratory study and provide a comprehensive description of the knowledge and attitudes held by gynecologists in Kazakhstan on the medical validity, diagnosis, and treatment of dyspareunia. DESIGN: This is an exploratory-descriptive qualitative study. METHODS: Semi-structured online interviews were conducted with 10 physicians. They were identified as obstetrics and gynecology specialists, gynecologic oncologists, and outpatient gynecologists. The average number of years spent practicing their specialty is 15.7, with the shortest being 4 years and the longest being 35 years. All the participants are female. Braun and Clarke's six-stage, step-by-step methodology was used for the thematic analysis. RESULTS: Findings suggest that gynecologists in Kazakhstan have knowledge of the most common causes of dyspareunia, although they still often attribute women's distress to psychological rather than physical factors. It was found that due to stigma and mutual embarrassment open dialogue about sexual health was lacking between patients and physicians. In addition, gynecologists describe difficulties discussing symptoms and performing intimate examinations due to time constraints and a lack of privacy at state facilities. CONCLUSION: To knowledgeably diagnose and treat patients with dyspareunia, gynecologists recommend further training to acquire the requisite evidence-based knowledge and competencies.

An Exploratory-Descriptive Qualitative Study of Kazakhstani Gynecologists' Knowledge and Attitudes Toward DyspareuniaBackground: Dyspareunia (pain during sex) is a common condition that causes physical and emotional distress in many women. Biological and psychological factors contribute to the onset of this condition, making diagnosis and management difficult for physicians. This painful condition can have a significant impact on women's physical, emotional, and psychological well-being, as well as their close relationships. Why was the study conducted? A thorough understanding of dyspareunia's causes, risk factors, and treatment techniques is required for effective management of the condition, but little research has been conducted in Kazakhstan on gynecologists' understanding of and attitudes toward dyspareunia. What did the researchers do? A qualitative study used online semi-structured interviews with gynecologists in Kazakhstan. What did the researchers find? The findings show that participating gynecologists are aware of the most common causes of dyspareunia, although they frequently attribute the condition to psychological rather than physical causes. It was found that due to stigma and mutual embarrassment, patients and participants did not engage in open discourse about sexual health. Furthermore, gynecologists have difficulty initiating discussions about women's sexual health and performing intimate examinations due to consultation time restrictions and a lack of privacy at state facilities. What do the researchers conclude? Additional training is recommended to gain the necessary evidence-based knowledge and competencies to accurately diagnose and treat patients with dyspareunia, and to address the lack of treatment protocols for dyspareunia in Kazakhstan, clinical guidelines published worldwide, including those issued by the American College of Obstetricians and Gynaecologists, may be considered for use in Kazakhstan.

Establishment and analysis of quality index system for pediatric tumor nursing.

BACKGROUND: Nursing management considers nursing quality management at its core. Evaluation indexes of nursing quality not only control nursing quality, measure work enthusiasm, and judge the difference in nursing levels but also help nurses accurately understand the satisfaction degree of patients. OBJECTIVE: To analyze pediatric tumor nursing quality evaluation indexes and establish a scientific and rigorous index system of children's nursing quality. METHODS:   Based on the "structure-process-result" in this study, the Delphi method was used to carry out questionnaire investigations and opinion collection for domestic experts in pediatrics, pediatric oncology internal medicine, and pediatric oncology surgical care and clinical aspects two times. In addition, the Kendall coordination coefficient and analytic hierarchy process were used to determine the content of indicators at all levels, set the weight, and finally establish the quality index system of pediatric tumor nursing. RESULTS: The response rate of 27 experts in the first round of the questionnaire was 100%, Ca0.77, Cs,0.73, Cr0.75, and the W value of the expert coordination coefficient was 0.315. In the second round of 27 expert consultations, the reply rate was 96%, Ca0.81, Cs0.80, Cr0.805, and the specialist coordination coefficient W value was 0.369. After two rounds of consultation, the importance evaluation scores of each indicator ranged from 3.31 to 4.88 and 3.29 to 5.00, respectively, and more than 94.7% of the indicators' importance evaluation scores were higher than 3.50. Finally, 3 Level-1 indicators, 12 Level-2 indicators, and 54 Level-3 indicators are established. CONCLUSION: This study has established a simple, comprehensive, and scientific quality index system for pediatric tumor nursing, highlighted the characteristics of pediatric tumor nursing, and provided an evaluation system for specialized nursing of pediatric tumors to more standardized pediatric tumor nursing and contribute to the sustainable and scientific development of pediatric tumor nursing.

In Situ Multi-Directional Liquid Manipulation Enabled by 3D Asymmetric Fang-Structured Surface.

Decorating surfaces with wetting gradients or topological structures is a prevailing strategy to control uni-directional spreading without energy input. However, current methods, limited by fixed design, cannot achieve multi-directional control of liquids, posing challenges to practical applications. Here, a structured surface composed of arrayed three-dimensional asymmetric fang-structured units is reported that enable in situ control of customized multi-directional spreading for different surface tension liquids, exhibiting five novel modes. This is attributed to bottom-up distributed multi-curvature features of surface units, which create varied Laplace pressure gradients to guide the spreading of different-wettability liquids along specific directions. The surface's capability to respond to liquid properties for multimodal control leads to innovative functions that are absent in conventional structured surfaces. Selective multi-path circuits can be constructed by taking advantage of rich liquid behaviors with the surface; surface tensions of wetting liquids can be portably indicated with a resolution scope of 0.3-3.4 mN m-1 using the surface; temperature-mediated change of liquid properties is utilized to smartly manipulate liquid behavior and achieve the spatiotemporal-controllable targeted cooling of the surface at its heated state. These novel applications open new avenues for developing advanced surfaces for liquid manipulation.

Qualitative study to explore the perspectives and mental health experiences of first episode psychosis patients and their caregivers in North India.

BACKGROUND: The onset of psychosis brings unfamiliar experiences that can be disturbing for patients and their caregivers. Few studies from India (only one from North India) have examined these experiences from the perspective of the patient and caregiver. We explored experiences of first episode psychosis (FEP) patients and their caregivers within a North Indian context. METHOD: Semi-structured interviews were conducted in 2019 with ten FEP patients and their caregivers (total n=20) receiving out-patient care in a tertiary care centre. Topic guides focused on concerns/complaints, symptoms, help-seeking, and barriers and facilitators to treatment. Interviews were audio recorded, transcribed, and analysed using qualitative content analysis. RESULTS: Main categories of responses from patients and caregivers included: initial complaints for seeking help, initial emotional response, barriers to seeking treatment, perceived dysfunction and improvement, experienced stigma, understanding about illness, early follow-up, preventive measures and awareness programs. Caregivers undergo myriad of emotional reactions including anger, anxiety, guilt, and confusion. Symptoms other than psychotic symptoms were the primary complaint upon seeking help, and there was lack of understanding about the psychosocial model of care (role of medications acknowledged with little awareness regarding psychosocial interventions in recovery). Persisting occupational dysfunction despite perceived symptomatic improvement was described by both patients and caregivers. CONCLUSION: North Indian patients with FEP lack awareness of symptoms. Therefore, onus for seeking help often falls on their caregivers. Psychoeducation from first contact with services and increasing awareness about psychotic illness within the community might help address lack of awareness about symptoms, mental health services, early signs of relapse, and importance of psychosocial interventions in achieving functional recovery.

Biodegradable Poly (L-Lactic acid) Fibrous Membrane with Ribbon-Structured Fibers and Ultrafine Nanofibers Enhances Air Filtration Performance.

Here, the poly (l-lactic acid) (PLLA) membrane with multi-structured networks (MSN) is successfully prepared by electrospinning technology for the first time. It is composed of micron-sized ribbon-structured fibers and ultrafine nanofibers with a diameter of tens of nanometers, and they are connected to form the new network structure. Thanks to the special fiber morphology and structure, the interception and electrostatic adsorption ability for against atmospheric particulate matter (PM) are significantly enhanced, and the resistance to airflow is reduced due to the "slip effect" caused by ultrafine nanofibers. The PLLA MSN membrane shows excellent filtration performance with ultra-high filtration efficiency (>99.9% for PM2.5 and >99.5% for PM0.3) and ultra-low pressure drop (≈20 Pa). It has demonstrated filtration performance that even exceeds current non-biodegradable polymer materials, laying the foundation for future applications of biodegradable PLLA in the field of air filtration. In addition, this new structure also provides a new idea for optimizing the performance of other polymer materials.

Bias due to coarsening of time intervals in the inference for the effectiveness of colorectal cancer screening.

BACKGROUND: Observational studies are frequently used to estimate the comparative effectiveness of different colorectal cancer (CRC) screening methods due to the practical limitations and time needed to conduct large clinical trials. However, time-varying confounders, e.g. polyp detection in the last screening, can bias statistical results. Recently, generalized methods, or G-methods, have been used for the analysis of observational studies of CRC screening, given their ability to account for such time-varying confounders. Discretization, or the process of converting continuous functions into discrete counterparts, is required for G-methods when the treatment and outcomes are assessed at a continuous scale. DEVELOPMENT: This paper evaluates the interplay between time-varying confounding and discretization, which can induce bias in assessing screening effectiveness. We investigate this bias in evaluating the effect of different CRC screening methods that differ from each other in typical screening frequency. APPLICATION: First, using theory, we establish the direction of the bias. Then, we use simulations of hypothetical settings to study the bias magnitude for varying levels of discretization, frequency of screening and length of the study period. We develop a method to assess possible bias due to coarsening in simulated situations. CONCLUSIONS: The proposed method can inform future studies of screening effectiveness, especially for CRC, by determining the choice of interval lengths where data are discretized to minimize bias due to coarsening while balancing computational costs.

Magnetic yolk-shell structured periodic mesoporous organosilica supported palladium as a powerful and highly recoverable nanocatalyst for the reduction of nitrobenzenes.

A novel palladium-loaded yolk-shell structured nanomaterial with magnetite core and phenylene-based periodic mesoporous organosilica (PMO) shell (Fe3O4@YS-Ph-PMO/Pd) nanocatalyst was synthesized for the reduction of nitrobenzenes. The Fe3O4@YS-Ph-PMO/Pd was prepared through cetyltrimethylammonium bromide (CTAB) directed condensation of 1,4-bis(triethoxysilyl)benzene (BTEB) around Fe3O4@silica nanoparticles followed by treatment with palladium acetate. This nanocatalyst was characterized by using Fourier transform infrared (FT-IR) spectroscopy, thermal gravimetric analysis (TGA), low-angle and wide-angle powder X-ray diffraction (PXRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM) and vibrating sample magnetometer (VSM) analyses. These analyses showed a magnetic nanomaterial with high chemical and thermal stability for the designed composite. The Fe3O4@YS-Ph-PMO/Pd nanocomposite was employed as a powerful and highly recoverable catalyst in the green reduction of nitroarenes in H2O at room temperature. A variety of nitroarene derivatives were applied as substrate in the presence of 0.9 mol% of Fe3O4@YS-Ph-PMO/Pd catalyst. All nitroarenes were selectively converted to their corresponding amines with high to excellent yields (92-96%) within short reaction times (10-18 min). This catalyst was recovered and reused at least 11 times without significant decrease in efficiency and stability.

Cutting Edge to Cutting Time: Can ChatGPT Improve the Radiologist's Reporting?

Radiology-structured reports (SR) have many advantages over free text (FT), but the wide implementation of SR is still lagging. A powerful tool such as GPT-4 can address this issue. We aim to employ a web-based reporting tool powered by GPT-4 capable of converting FT to SR and then evaluate its impact on reporting time and report quality. Thirty abdominopelvic CT scans were reported by two radiologists across two sessions (15 scans each): a control session using traditional reporting methods and an AI-assisted session employing a GPT-4-powered web application to structure free text into structured reports. For each radiologist, the output included 15 control finalized reports, 15 AI-assisted pre-edits, and 15 post-edit finalized reports. Reporting turnaround times were assessed, including total reporting time (TRT) and case reporting time (TATc). Quality assessments were conducted by two blinded radiologists. TRT and TATc have decreased with the use of the AI-assisted reporting tool, although statistically not significant (p-value > 0.05). Mean TATc for RAD-1 decreased from 00:20:08 to 00:16:30 (hours:minutes:seconds) and TRT decreased from 05:02:00 to 04:08:00. Mean TATc for RAD-2 decreased from 00:12:04 to 00:10:04 and TRT decreased from 03:01:00 to 02:31:00. Quality scores of the finalized reports with and without AI-assistance were comparable with no significant differences. Adjusting the AI-assisted TATc by removing the editing time showed statistically significant results compared to the control for both radiologists (p-value < 0.05). The AI-assisted reporting tool can generate SR while reducing TRT and TATc without sacrificing report quality. Editing time is a potential area for further improvement.

Structured training initiative (STI) for caregivers of children on peritoneal dialysis: a prospective study of the impact on the rate of peritonitis.

BACKGROUND: Training caregivers performing PD is an important measure to prevent peritonitis. A low literacy rate hinders training in low-resource settings. We designed a structured training initiative (STI) and objective structured assessment (OSA) using visual and kinesthetic resources with minimal use of written resources. We studied the impact of STIs on caregivers' knowledge and practical skills and the rate of peritonitis. METHODS: This prospective study conducted initial STI (iSTI) for caregivers of children initiating PD and retraining STI (rSTI) for those already on PD. OSA was administered after completion of training, and those scoring < 95% were retrained. Re-assessment was done at 3, 6, and 12 months, and those who scored < 95% underwent re-training. The rate of PD peritonitis and the time to first peritonitis were compared between the STI group and the cohort on PD in our center who received standard training before STI (controls). RESULTS: Caregivers of 40 children were included. The median duration of iSTI and rSTI was 19.5 (18, 20) and 9 (9, 9.5) hrs, and the OSA scores were 97% (97%, 98%) and 96% (96%, 98%), respectively. Only 5% required retraining. There was a significant reduction in the rate of PD peritonitis (0.29 vs. 0.69 episodes/patient-year; p < 0.001) and longer time to peritonitis (189 vs. 69 days; p < 0.001) in the STI group when compared to the controls (n = 32). CONCLUSIONS: STI was effective in training caregivers for peritoneal dialysis. There was a reduction in the rate of peritonitis and a longer time to first peritonitis in the STI cohort.

Adaptive Weighted Data Fusion for Line Structured Light and Photometric Stereo Measurement System.

Line structured light (LSL) measurement systems can obtain high accuracy profiles, but the overall clarity relies greatly on the sampling interval of the scanning process. Photometric stereo (PS), on the other hand, is sensitive to tiny features but has poor geometrical accuracy. Cooperative measurement with these two methods is an effective way to ensure precision and clarity results. In this paper, an LSL-PS cooperative measurement system is brought out. The calibration methods used in the LSL and PS measurement system are given. Then, a data fusion algorithm with adaptive weights is proposed, where an error function that contains the 3D point cloud matching error and normal vector error is established. The weights, which are based on the angles of adjacent normal vectors, are also added to the error function. Afterward, the fusion results can be obtained by solving linear equations. From the experimental results, it can be seen that the proposed method has the advantages of both the LSL and PS methods. The 3D reconstruction results have the merits of high accuracy and high clarity.

MR Evaluation of Placenta Accreta Spectrum: Concordance Rates and Effect of Structured Reporting on Patient Outcomes.

OBJECTIVE: To examine the concordance rate of MRI findings with intraoperative and pathologic findings in patients with Placenta Accreta Spectrum (PAS), as well as the use of structured reporting, and their relationship to clinical outcomes. METHODS: An IRB approved retrospective chart review was performed for patients with a history of cesarean delivery, a diagnosis of PAS on post-operative pathology report, and a placental MRI prior to delivery between 2008-2022. Concordance rates were calculated between final MRI, ultrasound, operative, and pathologic diagnoses, as well as impact on clinical outcomes. Quantitative variables were analyzed using a t-test. Categorical variables were analyzed using chi-squared and Fischer's exact tests. RESULTS: A total of 59 patients met initial inclusion criteria. Of these 59 patients, 8 (13.6%) were interpreted using structured reporting. Discordance between preoperative imaging, operative findings and final pathology diagnoses were associated with increased blood loss, blood transfusion, ICU admission, and postpartum length of stay. Structured reporting was found to significantly reduce the amount of diagnostic discordance (p=.017) and was associated with decreased ICU admissions when utilized (p=.045). CONCLUSIONS: Use of structured reporting in the interpretation of placental MRI may decrease the amount of discordance between imaging and intraoperative or pathologic diagnoses, which in our study is associated with improved patient outcomes including decreased blood loss and amount of blood transfused. Radiologists must be cognizant of key imaging features of PAS on MRI, as interpretation provides an opportunity to positively impact the quality and safety of patient care.

Administration of the American Board of Anesthesiology's virtual APPLIED Examination: successes, challenges, and lessons learned.

In response to the COVID-19 pandemic, the American Board of Anesthesiology transitioned from in-person to virtual administration of its APPLIED Examination, assessing more than 3000 candidates for certification purposes remotely in 2021. Four hundred examiners were involved in delivering and scoring Standardized Oral Examinations (SOEs) and Objective Structured Clinical Examinations (OSCEs). More than 80% of candidates started their exams on time and stayed connected throughout the exam without any problems. Only 74 (2.5%) SOE and 45 (1.5%) OSCE candidates required rescheduling due to technical difficulties. Of those who experienced "significant issues", concerns with OSCE technical stations (interpretation of monitors and interpretation of echocardiograms) were reported most frequently (6% of candidates). In contrast, 23% of examiners "sometimes" lost connectivity during their multiple exam sessions, on a continuum from minor inconvenience to inability to continue. 84% of SOE candidates and 89% of OSCE candidates described "smooth" interactions with examiners and standardized patients/standardized clinicians, respectively. However, only 71% of SOE candidates and 75% of OSCE candidates considered themselves to be able to demonstrate their knowledge and skills without obstacles. When compared with their in-person experiences, approximately 40% of SOE examiners considered virtual evaluation to be more difficult than in-person evaluation and believed the remote format negatively affected their development as an examiner. The virtual format was considered to be less secure by 56% and 40% of SOE and OSCE examiners, respectively. The retirement of exam materials used virtually due to concern for compromise had implications for subsequent exam development. The return to in-person exams in 2022 was prompted by multiple factors, especially concerns regarding standardization and security. The technology is not yet perfect, especially for testing in-person communication skills and displaying dynamic exam materials. Nevertheless, the American Board of Anesthesiology's experience demonstrated the feasibility of conducting large-scale, high-stakes oral and performance exams in a virtual format and highlighted the adaptability and dedication of candidates, examiners, and administering board staff.