OBJECTIVE:This study aims to comprehensively evaluate key benefits offered by various diagnostic radiology residency programs in the United States, focusing on stipends, research support, educational resources, time-off policies, mini-fellowships, and additional perks. The goal is to offer insights into the diverse landscape of resident compensation, as well as the variety and type of benefits. METHODS:Data collection utilized an anonymous survey of diagnostic radiology residency programs, addressing stipends, research support, educational resources, time-off policies, mini-fellowships, and additional benefits. A structured questionnaire facilitated responses from program representatives which were collected during March-April 2023. The survey employed quantitative and qualitative questions to gather comprehensive information. Descriptive statistics and correlations were subsequently performed to analyze the responses. RESULTS:Analysis of stipends revealed significant geographic and program-related variations, impacting resident compensation. Analysis of post pandemic era stipends showed that R1 stipends ranged from less than $45,000 to over $65,000, with statistically significant differences across geographic regions (p = 0.01). R1 stipends varied significantly across different Cost-of-Living Index (COLI) groups (p < 0.01). While most programs provide support for educational and research activities, such as conference leave and funding for specialized courses, there was considerable variability in the type and extent of benefits offered, reflecting a lack of standardization among residency programs. DISCUSSION:The study outcomes prompt actionable considerations for optimizing benefits provided by radiology residency programs. Geographic and program-specific stipend variations underscore the importance of establishing stipend compensation at par with cost-of-living expenses. Comprehensive knowledge of the trends and variation in residency benefits could guide program enhancements, with the overarching goal of supplementing current stipends to enhance resident satisfaction and well-being.

Many factors are associated with increased mortality in older adults. The presence of certain chronic medical conditions, multimorbidity, and declines in functional status have been shown in multiple studies to be associated with increased mortality in this population. Social determinants of health (SDOH) may also influence health outcomes. Sociodemographic factors including marital status, race, education, and occupational class have been associated with one-year mortality among hospitalized older veterans, and some of those SDOH have been associated with markedly increased 90-day mortality among hospitalized older adults. Post-acute and longterm care is often needed for older adults, especially veterans for whom there is a growing demand for both institutional and noninstitutional long-term care. Identification of specific sociodemographic and clinical characteristics that portend poor healthcare outcomes may help to identify those who are at greater risk for morbidity and mortality at discharge from the post-acute care setting. To characterize veterans at increased risk of mortality at discharge from post-acute care, we examined the association of sociodemographic and clinical characteristics on one-year mortality for veterans discharged from a veterans affairs (VA) affiliated transitional care unit (TCU). We hypothesized that veterans with more comorbidities and those who lived in rural areas would be more likely to have increased mortality at one-year after discharge from the TCU.

Objectives To assess associations between maternal smoking and congenital heart defects (CHDs) in offspring. Study design We performed a retrospective case-control study using data for cases of CHD (n = 8339) and non-malformed controls (n = 11 020) from all years (1997-2011) of the National Birth Defects Prevention Study. Maternal self-reported smoking 1 month before through 3 months after conception was evaluated as a binary (none, any) and categorical (light, medium, heavy) exposure. Multivariable logistic regression was used to estimate aOR and 95% Cls. Stratified analyses were performed for septal defects according to maternal age, prepregnancy body mass index, and maternal race/ethnicity. Results Multiple CHDs displayed modest associations with any level of maternal periconceptional smoking independent of potential confounders; the strongest associations were for aggregated septal defects (OR, 1.5; 95% CI, 1.3-1.7), tricuspid atresia (OR, 1.7; 95% CI, 1.0-2.7), and double outlet right ventricle (DORV) (OR, 1.5; 95% CI, 1.1-2.1). Tricuspid atresia and DORV also displayed dose-response relationships. Among heavy smokers, the highest odds were again observed for tricuspid atresia (aOR 3.0; 95% CI, 1.5-6.1) and DORV (aOR 1.5; 95% CI, 1.1-2.2). Heavy smokers >= 35 years old more frequently had a child with a septal defect when compared with similarly aged nonsmokers (aOR 2.3; 95% CI, 1.4-3.9). Conclusions Maternal periconceptional smoking is most strongly associated with septal defects, tricuspid atresia, and DORV; the risk for septal defects is modified by maternal age.

While chest tube placement with pleural fibrinolytic medication is the established treatment of pediatric empyema, treatment failure is reported in up to 20

Incident Serum Albumins (SA) have been extensively studied as a prognostic indicator in community-dwelling and hospitalized older adults. A meta-analysis showed the SA mean value for community-dwelling older adults was 4.1 g/dL and for hospitalized older adults was 3.6 g/dL [1]. Studies of community-dwelling older adults consistently demonstrate a strong inverse association between SA and the risk of mortality with a clear risk gradient demonstrated even within the reference range for SA [1-5]. Further, the incident SA remains significantly associated with mortality risk throughout the subsequent 12 years [1-4]. In contrast, studies of hospitalized older adults indicate that SA is an indicator of short-term mortality risk. In this setting, a strong inverse association has been identified between SA and the risk of mortality during the hospitalization and for up to 12 months post-discharge [1,6-9]. SA has not been shown to be a predictor of long-term survival among hospitalized patients [1,9]. This finding is consistent with the fact that SA is a negative acute phase reactant and that its concentration drops in response to acute inflammatory conditions; in this sense, SA has been considered an indicator of illness severity among hospitalized older adults and may not reflect an individual’s baseline health status [1,9].

Purpose: This randomized, placebo-controlled, double-blind, dose-escalation acute ischemic stroke trial was designed to demonstrate maximum tolerated dose, characterize adverse events (AEs), and explore clinical outcomes when intravenous dodecafluoropentane emulsion (DDFPe) was used as neuroprotection. Methods: Acute ischemic stroke patients (n = 24) with National Institutes of Health Stroke Scale (NIHSS) score of 2-20 were randomized to either 3 doses of intravenous DDFPe or placebo, 1 every 90 minutes, starting within 12 hours of symptom onset. Doses were given without affecting standard stroke care. Each of the 3 dose cohorts included 8 patients, with 2 receiving placebo and 6 receiving DDFPe. Primary outcomes were serious adverse events (SAEs), AEs, NIHSS score, and modified Rankin Score (mRS). Results: No dose-limiting toxicities were encountered, and no maximum tolerated dose was defined. One unrelated delayed death occurred in a DDFPe patient, and another occurred in the placebo group. Group SAEs and AEs were similar in incidence and severity. Early initiation of DDFPe treatment resulted in better NIHSS score response than late initiation (P = .03). Thirty- and 90-day mRS after high-dose therapy suggested clinical improvement (P = .01 and P = .03, respectively). However, the significance of differences in clinical outcomes was limited by small patient numbers and differences in stroke severity between cohorts. Conclusions: Intravenous DDFPe appears to be safe at all doses tested. Clinical improvements in NIHSS score and mRS were significant but compromised by small sample size.

Apathy is a common and disabling behavioral concomitant of many neurodegenerative conditions including Alzheimer's disease (AD), and improving apathy may slow the neurodegenerative process. Frontal lobe dysfunction and hypodopaminergic state in the brain are implicated in the etiology of apathy. Since repetitive transcranial magnetic stimulation (rTMS) to frontal lobe of the brain increases dopamine, we hypothesized that rTMS would improve apathy in AD. The objective was to investigate the efficacy and safety of rTMS in improving apathy in older adults with AD. A 4-week, prospective, double-blind, randomized, sham-controlled study was conducted in older adults (N=20) with apathy and AD. Subjects were randomized to active rTMS or sham treatment (5 days/week) for 4 weeks for a total of 20 treatments. Treatment parameters were set at 10hz stimulation, 120% motor threshold (MT), and 3000 pulses per treatment although there were protocols in place to lower the MT if necessary. The primary (apathy (Apathy Evaluation Scale-Clinician version)) and secondary (cognition (Modified Mini Mental State Examination (3MS) & MMSE), executive function (TMT-A, TMT-B, Exit-25), functional status (ADL, IADL), clinical global impression (CGI-I, CGI-S), and caregiver burden (ZBS)) outcomes were assessed at baseline and 4 weeks. Nineteen subjects completed the study. Mean age was 77.3 (±7.2) years, 80% were Caucasians and 10% were females. After adjusting for baseline, there was a significantly greater improvement in the AES-C with active rTMS compared to sham treatment [-10.1 (-15.9 to -4.3); p=0.002] at 4 weeks. There was significantly greater improvement in 3MS (p=0.030), IADL (p=0.006), CGI-S (p=0.007), and CGI-I (p<0.001) with rTMS compared to the sham treatment. Treatment site discomfort was the most common adverse event. None of the subjects had a seizure. rTMS may be used safely in subjects with AD and may improve apathy and cognition.

An elevated blood urea nitrogen (BUN) in known to be an important prognostic indicator in patients with end-stage heart or kidney disease or certain other life-threatening illnesses. However, it is less certain as to whether an elevated BUN is an independent predictor of long-term mortality risk in less seriously ill patients. To address this issue, we examined the relationship between BUN and long-term mortality after adjusting for potential confounders and other indicators of health status/disease severity, in a select population of older medically stable Veterans.

Apathy is a common and disabling behavioral concomitant of many neurodegenerative conditions. The presence of apathy with Mild Cognitive Impairment (MCI) is linked with heightened rates of conversion to Alzheimer's disease. Improving apathy may slow the neurodegenerative process. The objective was to establish the efficacy of repetitive transcranial magnetic stimulation (rTMS) in improving apathy in older adults with MCI. An 8-week, double-blind, randomized, sham-controlled cross-over study was conducted in nine subjects (66 ± 9 years) with apathy and MCI. Subjects were randomized to rTMS or sham treatment (5 days/week) for 2 weeks following which they underwent a 4-week treatment-free period. Subjects then crossed-over to receive the other treatment for 2 weeks. The primary (apathy (AES-C)) and secondary (cognition (3MS & MMSE), executive function (TMT-A & TMT-B), and clinical global impression (CGI)) outcomes were assessed at baseline, 2, 6, and 8 weeks. After adjusting for baseline, there was a significantly greater improvement in the AES-C with rTMS compared to sham treatment at 2 weeks. There was significantly greater improvement in 3MS, MMSE, TMT-A, and CGI-I with rTMS compared to the sham treatment. This study establishes that rTMS is efficacious in improving apathy in subjects with MCI.

Complicated pleural effusion prolongs the hospital course of pneumonia. Chest tube placement with instillation of fibrinolytic medication allows efficient drain output and decreases hospital stay.

BACKGROUND/OBJECTIVE:Balance problems are common in older adults with Alzheimer's disease (AD). The objective was to study the effects of a Wii-Fit interactive video-game-led physical exercise program to a walking program on measures of balance in older adults with mild AD.METHODS:A prospective randomized controlled parallel-group trial (Wii-Fit versus walking) was conducted in thirty community-dwelling older adults (73±6.2 years) with mild AD. Home-based exercises were performed under caregiver supervision for 8 weeks. Primary (Berg Balance Scale, BBS) and secondary outcomes (fear of falls and quality of life) were measured at baseline, 8 weeks (end of intervention), and 16 weeks (8-weeks post-intervention).RESULTS:At 8 weeks, there was a significantly greater improvement (average inter-group difference [95% CI]) in the Wii-Fit group compared to the walking group in BBS (4.8 [3.3-6.2], p < 0.001), after adjusting for baseline. This improvement was sustained at 16 weeks (3.5 [2.0-5.0], p < 0.001). Analyses of the secondary outcome measures indicated that there was a significantly greater improvement in the Wii-Fit group compared to walking group in Activity-specific Balance Confidence scale (6.5 [3.6-9.4], p < 0.001) and Falls Efficacy Scale (-4.8 [-7.6 to -2.0], p = 0.002) at 8 weeks. However, this effect was not sustained at 16 weeks. Quality of life improved in both groups at 8 weeks; however, there were no inter-group differences (p = 0.445).CONCLUSION:Home-based, caregiver-supervised Wii-Fit exercises improve balance and may reduce fear of falling in community-dwelling older adults with mild AD.

Background/Objectives. Balance problems are well-established modifiable risk factors for falls, which are common in older adults. The objective of this study was to establish the efficacy of a Wii-Fit interactive video-game-led physical exercise program to improve balance in older Veterans. Methods. A prospective randomized controlled parallel-group trial was conducted at Veterans Affairs Medical Center. Thirty community dwelling Veterans aged 68 (±6.7) years were randomized to either the exercise or control groups. The exercise group performed Wii-Fit program while the control group performed a computer-based cognitive program for 45 minutes, three days per week for 8-weeks. The primary (Berg Balance Scale (BBS)) and secondary outcomes (fear of falling, physical activity enjoyment, and quality of life) were measured at baseline, 4 weeks, and 8 weeks. Results. Of 30 randomized subjects, 27 completed all aspects of the study protocol. There were no study-related adverse events. Intent-to-treat analysis showed a significantly greater improvement in BBS in the exercise group (6.0; 95% CI, 5.1–6.9) compared to the control group (0.5; 95% CI, −0.3–1.3) at 8 weeks (average intergroup difference (95% CI), 5.5 (4.3–6.7), p < 0.001) after adjusting for baseline. Conclusion. This study establishes that the Wii-Fit exercise program is efficacious in improving balance in community dwelling older Veterans. This trial is registered with ClinicalTrials.gov Identifier NCT02190045.

OBJECTIVE Apathy is a common behavioral problem in Alzheimer's disease. Apathy has profound consequences, such as functional impairment, higher service utilization, higher caregiver burden, and increased mortality. The authors' objective was to study the effects of methylphenidate on apathy in Alzheimer's disease. METHOD A 12-week, prospective, double-blind, randomized, placebo-controlled trial (methylphenidate versus placebo) was conducted in community-dwelling veterans (N=60) with mild Alzheimer's disease. The primary outcome for apathy (Apathy Evaluation Scale-Clinician) and secondary outcomes for cognition (Mini-Mental State Examination, Modified Mini-Mental State Examination), functional status (activities of daily living, instrumental activities of daily living), improvement and severity (Clinical Global Impressions Scale [CGI]), caregiver burden (Zarit Burden Scale), and depression (Cornell Scale for Depression in Dementia) were measured at baseline and at 4, 8, and 12 weeks. RESULTS Participants were all men (77 years old, SD=8). After adjusting for baseline, the methylphenidate group had significantly greater improvement in apathy than the placebo group at 4 weeks, 8 weeks, and 12 weeks. At 12 weeks, there was also greater improvement in cognition, functional status, caregiver burden, CGI scores, and depression in the methylphenidate group compared with the placebo group. CONCLUSIONS Methylphenidate improved apathy in a group of community-dwelling veterans with mild Alzheimer's disease. Methylphenidate also improved cognition, functional status, caregiver burden, CGI scores, and depression.

The purpose of this study was to evaluate a multi-component method for capturing nutrient intake, which used observation, photography, and an innovative computer program. To assess reliability and accuracy, multiple responsible employees (REs) independently conducted nutrient intake assessments on simulated meals; each RE’s results relating to energy intake were compared to those from the other REs and to those obtained by pre- and post-meal weighing of the food items. System efficiency was assessed by having REs perform independent assessments on the same set of simulated meals using either the new or traditional hospital method for which the REs had to document each food item served and then find the items in a computer database–steps that were automated in the new method. Interrater reliability for energy intake estimated on clinic wards was excellent (intraclass correlation coefficient = 0.975, 95% CI 0.958 to 0.992) and there was a high level of agreement between the REs’ estimates and the true values determined by food weighing; per the method of Bland and Altman the mean difference between the two types of estimates was 0.3 kcal (95% CI, −8.1 to 8.7 kcal) with limits of agreement of −79.5 kcal to 80.1 kcal. Compared to the traditional method, energy intake assessments could be completed using the multi-component method in less than a third of the time. These results indicate the multi-component method is an accurate, reliable, and efficient method of obtaining energy intake assessments for hospitalized patients.

A preliminary PET evaluation of dodecafluoropentane emulsion effects on rabbit brain hypoxia in stroke J.S. Nix, A. Brown, R.D. Skinner, M. Berridge, M. James, P.K. Roberson, W.C. Culp; College of Medicine, University of Arkansas for Medical Sciences, Hope, AR; Radiology, University of Arkansas for Medical Sciences, Little Rock, AR; Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR; College of Medicine Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR

Dodecafluoropentane emulsion (DDFPe) nanodroplets are exceptional oxygen transporters and can protect ischemic brain in stroke models 24 h without reperfusion. Current stroke therapy usually fails to reach patients because of delays following stroke onset. We tested using DDFPe to extend the time window for tissue plasminogen activator (tPA). Longer treatment windows will allow more patients more complete stroke recovery. We test DDFPe to safely extend the time window for tPA thrombolysis to 9 h after stroke. With IACUC approval, randomized New Zealand white rabbits (3.4–4.7 kg, n = 30) received angiography and 4-mm blood clot in the internal carotid artery for flow-directed middle cerebral artery occlusion. Seven failed and were discarded. Groups were IV tPA ( n = 11), DDFPe + tPA ( n = 7), and no therapy controls ( n = 5). DDFPe (0.3 ml/kg, 2 % emulsion) IV dosing began at 1 h and continued at 90 min intervals for 6 doses in one test group; the other received saline injections. Both got standard IV tPA (0.9 mg/kg) therapy starting 9 h post stroke. At 24 h, neurological assessment scores (NAS, 0–18) were determined. Following brain removal percent stroke volume (%SV) was measured. Outcomes were compared with Kruskal-Wallis analysis. For NAS, DDFPe + tPA was improved overall, p = 0.0015, and vs. tPA alone, p = 0.0052. For %SV, DDFPe + tPA was improved overall, p = 0.0003 and vs. tPA alone, p = 0.0018. NAS controls and tPA alone were not different but %SV was, p = 0.0078. With delayed reperfusion, DDFPe + tPA was more effective than tPA alone in preserving functioning brain after stroke. DDFPe significantly extends the time window for tPA therapy.

Dodecafluoropentane emulsion (DDFPe) has been shown in animal models to reduce brain infarct volume caused by ischemic stroke and is being studied as a potential neuroprotective drug. The mechanism of the tissue-saving effect of DDFPe remains uncertain, but increased oxygen transportation has been shown in vitro. MicroPET scans were performed using Fluorine-18 Fluoromisonidazole (FMiso), a tracer that exhibits uptake proportional to hypoxia in viable tissue. The preliminary results suggest that DDFPe curtails hypoxia in the brain following stroke. New Zealand White Rabbits (n=9) underwent angiographic embolization of the middle cerebral artery (MCA) using permanent injectable spheres, and intravenous FMiso was administered. PET scans evaluated the period 2 hours post FMiso injection, allowing the tracer time to distribute. Treatment group animals received IV 0.6 mL/kg of 2% w/v DDFPe within 2 hours of embolization, not exceeding 2.5 mL. Standardized uptake values (SUV) were calculated for stroked regions of interest (ROI) every 5 minutes over 30 minutes. In the case of unidentifiable stroke after treatment, an ROI was drawn in an area typical of MCA territory. Rabbits were sacrificed and brains were harvested for infarct volume measurement. Because of the need for typical strokes, infarct criteria were applied based on previous, published experience. Three animals were excluded, 1 control that failed to have a significant infarct and 2 for procedural failures, leaving 3 controls and 3 treated. Mean ±SE SUVs ranged from 0.50 ±0.06 to 0.60 ±0.06 for DDFPe treatments and 1.06 ±0.15 to 1.30 ±0.17 for controls. The DDFPe group showed decreased hypoxia with P values less than 0.05 at each time point using Wilcoxon rank sum test. The reduction of FMiso in stroked ROIs as indicated by lower SUVs shows the ability of DDFPe to alleviate hypoxia in areas of ischemia. Furthermore, the oxygenating effect persists beyond the DDFPe 2 minute blood half-life in rabbits. Further study is warranted.