Faculty Bibliography

Seizures associated with low-grade tumors in pediatric patients can be drug resistant and associated with significant morbidity. There are several low-grade tumor types associated with epilepsy in this population with the majority localized to the temporal lobe and some extra-temporal locations (frontal, parietal, and occipital lobes). The primary treatment of low-grade epilepsy-associated tumors is surgical resection, though the surgical approach and the use of intraoperative techniques remain controversial. Newer treatments are under investigation as primary and/or adjunctive therapy, including non-invasive surgical options and gene-targeted therapy. A multimodal approach to treatment may improve long-term outcomes and quality of life.

PURPOSE/UNASSIGNED:Urine calcium excretion is greater after dinner and urine volumes are lower. The result is higher urine calcium concentrations, which may confer greater risk of stone formation, at night. We considered whether night-time administration - as compared with daytime administration - of thiazides would be more effective for stone prevention. MATERIALS AND METHODS/UNASSIGNED:We performed 12-hour urine collections in 7 patients taking 25 mg of chlorthalidone (CTD) and 10 patients taking 25 mg of hydrochlorothiazide (HCTZ). Participants completed urine collections at baseline, again after a week of morning medication administration, and again after a week of evening administration, all on repeated self-selected diets. RESULTS/UNASSIGNED:Chlorthalidone reduced urine calcium excretion for both 12-hour periods whether administered in the morning or in the evening: morning dosing lowered urine calcium from 130±70 mg/gram Cr at baseline, to 76±52 mg/gram Cr (P<0.02); evening dosing lowered it to 87±51 mg/gram Cr, which was not significant. On the other hand, HCTZ did not reduce urine calcium excretion regardless of the time of administration: mean 24-hour urine calcium excretion (UCa) was 124±38 mg/gram Cr at baseline and 106±40 mg/gram Cr when HCTZ was given in AM, and 117±54 mg/gram Cr when given in PM. CONCLUSION/UNASSIGNED:We conclude that the long-acting and more effective CTD is a preferable agent for stone prevention. Time of administration does not appear to be important, although morning administration may more effectively address higher post-dinner calcium excretion. The most commonly used thiazide (HCTZ) is shorter acting, frequently dosed once per day, but does not appear to reduce urine calcium excretion at this dose.

OBJECTIVE/UNASSIGNED:The authors aimed to characterize the long-term psychiatric outcomes and their predictors among survivors of autoimmune encephalitis (AE). METHODS/UNASSIGNED:In this retrospective cohort study, patients diagnosed as having AE between 2008 and 2023 at two academic medical centers (in New York City and Toronto) completed the Mini International Neuropsychiatric Interview 7.0.2 (MINI) and Profile of Mood States (POMS-2) to assess long-term psychiatric outcomes. Clinical characteristics were assessed for potential predictors of psychiatric outcomes. Bivariate analyses and univariate logistic regressions were conducted to assess the relationship between the predictors and the primary outcome. RESULTS/UNASSIGNED:-methyl-d-aspartate (33%), anti-leucine-rich-glioma-inactivated 1 (24%), anti-glutamic acid decarboxylase 65 (14%), and antibody-negative encephalitis (29%). In total, 71% of participants who completed the MINI met criteria for a DSM-5 diagnosis, and 56% were diagnosed as having a mood disorder. Thirteen participants (31%) reported above-average total mood disturbance on the POMS-2. Mann-Whitney U tests revealed that participants diagnosed as having a mood disorder self-reported significantly higher levels of confusion and bewilderment (z=-2.04, p=0.04) and depression and dejection (z=-2.24, p=0.03) and lower levels of vigor and activity (z=-2.62, p=0.01). CONCLUSIONS/UNASSIGNED:AE survivors have a high prevalence of psychiatric comorbid conditions, with most being diagnosed as having a mood disorder and a significant proportion endorsing ongoing mood disturbance. Patients with a psychiatric history may benefit from closer psychiatric follow-up.

BACKGROUND AND PURPOSE/OBJECTIVE:This study aims to analyze the gap between the number of radiologist jobs listed in a single major US job posting center and the number of anticipated graduating general diagnostic radiology and neuroradiology trainees through the National Resident Matching Program as a primary source of radiologists to fulfill radiologist workforce needs. MATERIALS AND METHODS/METHODS:Job listings between 2014-2023 from a single large US radiology job listing source were collected for the total number of unique annual job listings, divided between neuroradiology-only, some component of neuroradiology, and no component of neuroradiology. National Resident Matching Program data were collected for PGY-2 Diagnostic Radiology Residency and Neuroradiology Fellowship Match to estimate the number of general radiologists and neuroradiologists in the training pipeline graduating in the corresponding job listing year. The difference between the number of job listings and anticipated graduating trainees was calculated and extrapolated for the future. RESULTS:Between 2014-2023, 31,825 jobs were listed in the ACR Career Center with 10,180 anticipated diagnostic radiology residency graduates during the same time period, for a ten-year cumulative deficit of 21,645 anticipated diagnostic radiology graduates. For neuroradiology-only jobs, the mismatch between job listings and anticipated fellowship trained neuroradiologists was 2,748 jobs to 1,933 graduates. For all jobs, the mismatch between anticipated radiology training graduates and job listings grew over this time-period. CONCLUSIONS:There is a growing mismatch between diagnostic radiology job listings on a major job listing board compared to the anticipated pipeline of general radiologists and neuroradiologists entering training through the NRMP Matching Program. This mismatch between the current growing need for radiologists and the training pipeline may help inform practice and training leaders seeking to mitigate the radiologist shortage. ABBREVIATIONS/BACKGROUND:NRMP = National Resident Matching Program; PGY-2 = Post-Graduate Year-2; ACR = American College of Radiology; PACS = Picture Archival and Communications System; ABR = American Board of Radiology; ACGME = Accreditation Council for Graduate Medical Education.

BACKGROUND:Nursing documentation burden is a growing point of concern in the United States healthcare system. Documentation in the electronic health record (EHR) is a contributor to perceptions of burden. Efficiency tools like flowsheet macros are one development intended to ease the burden of documentation. OBJECTIVE:Evaluate if flowsheet macros, a documentation efficiency tool in the EHR that consolidates documentation into a single click, reduces the time spent in documentation activities and the EHR overall. METHODS:Nurses in the health system were encouraged to create and utilize flowsheet macros for their documentation. Flowsheet documentation and time in system data for nurses' first and last shift in the evaluation period was extracted from the EHR. Linear regression with control variables was utilized to understand if utilization of flowsheet macros for documentation reduced the time spent in flowsheets or the EHR. RESULTS:The results of linear regression showed a significant, negative relationship between flowsheet macros use and time in flowsheets (AOR = -0.291, CI = -0.342 - -0.240, p < 0.001). Flowsheet macros use and time in system also had a significant, negative relationship (AOR = -0.269, CI = -0.390 - -0.147, p = <0.001). Subgroups for department specialties showed time savings in flowsheet activities for medical surgical, critical care, and obstetrics units, however a significant relationship was not found in emergency and rehabilitation units. CONCLUSION/CONCLUSIONS:Utilization of flowsheet macros was associated with a decrease in the amount of time a nurse spends in both flowsheets and the EHR. Adoption and time savings varied by the department setting, suggesting flowsheet macros may not be applicable to all patient types or conditions. Future research should investigate if the time savings from this tool yield benefits in perceptions of nurse documentation burden.

BACKGROUND AND PURPOSE/OBJECTIVE:Perfusion and perfusion-related parameter maps obtained using dynamic susceptibility contrast (DSC) MRI and dynamic contrast enhanced (DCE) MRI are both useful for clinical diagnosis and research. However, using both DSC and DCE MRI in the same scan session requires two doses of gadolinium contrast agent. The objective was to develop deep-learning based methods to synthesize DSC-derived parameter maps from DCE MRI data. MATERIALS AND METHODS/METHODS:Independent analysis of data collected in previous studies was performed. The database contained sixty-four participants, including patients with and without brain tumors. The reference parameter maps were measured from DSC MRI performed following DCE MRI. A conditional generative adversarial network (cGAN) was designed and trained to generate synthetic DSC-derived maps from DCE MRI data. The median parameter values and distributions between synthetic and real maps were compared using linear regression and Bland-Altman plots. RESULTS:Using cGAN, realistic DSC parameter maps could be synthesized from DCE MRI data. For controls without brain tumors, the synthesized parameters had distributions similar to the ground truth values. For patients with brain tumors, the synthesized parameters in the tumor region correlated linearly with the ground truth values. In addition, areas not visible due to susceptibility artifacts in real DSC maps could be visualized using DCE-derived DSC maps. CONCLUSIONS:DSC-derived parameter maps could be synthesized using DCE MRI data, including susceptibility-artifact-prone regions. This shows the potential to obtain both DSC and DCE parameter maps from DCE MRI using a single dose of contrast agent. ABBREVIATIONS/BACKGROUND:=plasma volume.

PURPOSE/UNASSIGNED:To determine the characteristics of normal tension glaucoma referrals at a tertiary care center and risk factors associated with unilateral versus bilateral disease. PATIENTS AND METHODS/UNASSIGNED:Medical records were reviewed of patients who were referred to a single glaucoma provider at a tertiary care center and were given a presumptive diagnosis of normal tension glaucoma (NTG) between the years 2018 and 2021. Data collected included demographics, medical and family history, ophthalmic history, ophthalmic examination findings, neuro-ophthalmology referrals, and magnetic resonance imaging (MRI) results. RESULTS/UNASSIGNED:A total of 98 patients were included in this study. The majority of patients (82%) had bilateral disease at initial presentation. Most patients (65%) had a history of systemic disease, including hypertension (32%), cardiovascular disease (19%), diabetes (12%), obstructive sleep apnea (10%), or orthostatic hypotension (4%). Conditions associated with vascular dysregulation were identified in 24% of patients. Sixty six percent of patients had a family history of glaucoma, while nearly half (49%) were myopic. Of patients with unilateral disease, 39% had workup or consideration of other neuro-ophthalmic diagnoses compared to 13% of patients with bilateral disease (P = 0.01). CONCLUSION/UNASSIGNED:Patients referred for NTG commonly present with disc changes in both eyes. Clinicians should assess for the presence of systemic diseases associated with vascular dysregulation, myopia, and a family history of glaucoma. Patients with unilateral disease consistent with NTG may benefit from additional workup including neuroimaging or a neuro-ophthalmic evaluation.

Food allergy therapy has experienced rapid growth over the past five years. In addition to avoidance measures and reactive treatment of accidental exposures, physicians can now offer patients multiple therapies for reducing the risk of severe reactions upon accidental exposure, and potentially achieving sustained remission. Many promising therapies are also in the pipeline. In this review, we outline the clinical management of food allergy, including mainstream non-pharmaceutical therapies, such as food oral immunotherapy (OIT), as well as three FDA-approved therapies: Palforzia (pharmaceutical peanut oral immunotherapy), omalizumab (anti-IgE monoclonal antibody), and Neffy (intranasal epinephrine). We also discuss emerging therapies, including novel routes of immunotherapy administration (epicutaneous, subcutaneous, sublingual, oral mucosal) and existing immunomodulatory therapies undergoing trials for use in food allergy, including dupilumab (anti-IL-4 and IL-13 monoclonal antibody), abrocitinib (oral JAK inhibitor) and abatacept (IgG-CTLA-4 fusion protein).

Toddler visual attention development correlates with subsequent language, cognitive, and social developmental outcomes. This study investigates the association of maternal trauma on toddler looking behaviors in 39 mother-child dyads from the Western Cape Province, South Africa. At 15 months postpartum, maternal trauma was assessed using the Life Events Checklist and toddler multisensory attention skills were measured using the Multisensory Attention Assessment Protocol (MAAP) during eye-tracking. We used two-way mixed ANOVA to analyze the association of maternal trauma and MAAP condition with attention maintenance, intersensory matching, and attention shifting. This study provides support for the MAAP's reliability with a sample of 15-month-old toddlers from a low-income setting. We observed a significant interaction between MAAP condition and maternal trauma group on attention maintenance, but pairwise comparisons did not meet the threshold for statistical significance. In a stratified analysis, toddlers of mothers in the low trauma exposure group demonstrated significant differences in attention maintenance, intersensory matching, and attention shifting by condition. Unexpectedly, toddlers of mothers in the high trauma exposure group did not exhibit significant differences in these attentional skills, potentially indicating attentional adaptations. Further research is needed to explore the relationship between the intergenerational transmission of trauma on infant and toddler multisensory attention skills in low-income settings.