Citations

Introduction: Several recent studies have shown a gender disparity in professional doctoral introductions at major medical conferences, with female speakers being less likely to be introduced with a professional title. We sought to examine whether a similar disparity existed at the American Society of Hematology (ASH) Annual Meeting. Methods: In this retrospective observational study, 8 investigators reviewed available presentations from video archives of the 2018 ASH Annual Meeting. Presentations were excluded if gender could not be identified and/or speaker did not have a doctoral degree. We collected data on speaker gender, speaker academic/non-academic rank, speaker geographic location, speaker training status, speaker session type and introducer gender were all collected. A "professional address" was defined as either "Dr. [First and Last Name]" or "Dr. [Last Name]." Descriptive statistics and regression modelling were used to analyze the data. Results:Of the videos reviewed, 645 presentations were eligible for analysis; 380 (59%) speakers were men and 264 (41%) were women. A comparison of male and female speaker cohorts is seen in Table 1. Forty-eight percent of both men and women held a Medical Doctor degree (MD), and the rest were MD/PhD or PhD graduates. Substantially more men (28%) were full professors compared to women (13%). Almost half (47%) of session types for both men and women speakers were designated as "basic science." In an adjusted analysis, more women (N=174, 66%) compared to men (N=225, 59%) received a professional address (P<.01). 43% of women were introduced by a female introducer and 42% of men were introduced by a female introducer (P=.79). In addition, 48 of the introducers (19%) for women and 68 of the introducers (18%) for men had a PhD or MD/PhD. In a logistic regression model adjusting for session type, academic rank, degree, geographic location, trainee status, and gender of introducer, there were no significant gender-based differences in professional introduction [Table 1; Odds Ratio (OR) 0.71, P=.06]. In addition, speakers with MD introducers were more likely to have a professional introduction compared to PhD introducers (OR 2.15, P=.03) regardless of sex. Conclusions: Our study demonstrates that women were at least as likely as men to receive a professional address at the 2018 ASH Annual Meeting. These results differ from previous studies of other professional medical conferences. These findings may reflect the strong presence of PhD graduates as both speakers and introducers. Both forms of bias (gender and degree-based) merit further study and interventions including speaker training to ensure combatting unconscious bias. Disclosures Velazquez: Midatech: Other: Husband owns stock in this company; Portola Pharmaceuticals: Other: Husband owns stock in this company; Corbus Pharmaceuticals: Other: Husband owns stock in this company; Johnson & Johnson: Other: Husband is employed by this company.

PurposeFiltering measured projections with a particular convolutional kernel is an essential step in analytic reconstruction of computed tomography (CT) images. A tradeoff between noise and spatial resolution exists for different choices of reconstruction kernel. In a clinical setting, this often requires producing multiple images reconstructed with different kernels for a single CT exam, which increases the burden of computation, networking, archival, and reading. We address this problem by training a deep convolutional neural network (CNN) to synthesize multiple input images into a single output image which exhibits low noise while also preserving features in images reconstructed with the sharpest kernels.MethodsA CNN architecture consisting of repeated blocks of residual units containing a total of 20 convolutional layers was used to combine features. The CNN inputs consisted of two images produced with different reconstruction kernels, one smooth and one sharp, which were stacked in the channel dimension. The network was trained using supervised learning with both full‐dose and simulated quarter‐dose abdominal CT images. After training, the performance was evaluated using a reserved set of full‐dose scans that were not used for network optimization. Noise reduction performance was measured by comparing root mean square (RMS) measurements in uniform regions. Spatial resolution was compared using line profiles of anatomic features.ResultsFor the regions tested, the synthetic images feature noise levels slightly below those of the smooth input images, while maintaining the resolution of anatomic details found in the sharp input images.ConclusionsA deep CNN can be used combine features from CT images reconstructed with different kernels to produce a single synthesized image series that exhibits both low noise and high spatial resolution. This approach has implications for improving image quality, reducing radiation dose, and simplifying the clinical workflow for CT imaging.

PurposeTo evaluate the quantitative accuracy and dose efficiency of simultaneous imaging of two contrast agents using dual‐energy computed tomography (DECT), two imaging tasks each representing one potential clinical application were investigated in a phantom study: biphasic liver imaging with iodine and gadolinium, and small bowel imaging with iodine and bismuth.MethodsTo separate and quantify mixtures of two contrast agents using a single DECT scan, mixed iodine and gadolinium samples were prepared with the contrast enhancement values corresponding to the late arterial (iodine) and the portal‐venous (gadolinium) phase for biphasic liver imaging. Mixed iodine and bismuth samples were prepared mimicking the arterial (iodine) and the enteric (bismuth) enhancement for small bowel imaging. For comparison to the reference condition of performing two single‐energy CT (SECT) scans, contrast samples were prepared separately to mimic separate scans in the arterial/venous phase and arterial/enteric enhancement. Samples were placed in a 35 cm wide water tank and scanned using a third‐generation dual‐source DECT scanner with three tube potential pairs: 80/Sn150, 90/Sn150, and 100/Sn150 kV, all with default dose partitioning between two x‐ray beams to acquire DECT data. The same scanner operated in a single‐energy mode acquired SECT data (120 kV). Total radiation dose (CTDIvol) was matched for the single‐scan DECT and the two‐scan SECT protocols. The DECT protocol was followed by a generic image‐based three‐material decomposition method to determine the material‐specific images, based on which concentrations of each basis material were quantified and noise levels were measured. To compare with the SECT images directly acquired with the SECT protocol, the concentration values in each contrast‐specific image were converted to CT numbers at 120 kV (i.e., virtual SECT (vSECT) images). The noise level and noise power spectra differences between the SECT and vSECT images were compared to evaluate the dose efficiency of the single‐scan DECT protocol. The impact of dose partitioning in the DECT protocol on quantitative dual‐contrast imaging performance was also studied.ResultsFor each imaging task, contrast materials were accurately quantified against the nominal concentrations using the DECT data with strong correlation (R2 ≥ 0.98 for both imaging tasks). Compared to the SECT protocol, the DECT protocol was not dose efficient. With the optimal x‐ray tube potential pair 80/Sn150 kV, the noise level in vSECT images increased by 401%/488% (arterial/portal‐venous) for the biphasic liver imaging task and by 10%/41% (arterial/enteric) for the small bowel imaging task compared to that in SECT images. The corresponding radiation dose increase is 2410%/3357% for the biphasic liver imaging task and 21%/99% for the small bowel imaging task, respectively, to achieve the same noise as that in SECT images. This could be improved by adjusting the dose partitioning in DECT.ConclusionsDECT can be used to simultaneously separate and quantify two contrast materials. However, compared to a two‐scan SECT protocol, much higher radiation dose is needed in a single‐scan DECT protocol to achieve the same image noise, especially for tasks involving the dual contrast of iodine and gadolinium.

With its first administration of an Objective Structured Clinical Examination (OSCE) in 2018, the American Board of Anesthesiology (ABA) became the first US medical specialty certifying board to incorporate this type of assessment into its high-stakes certification examination system. The fundamental rationale for the ABA’s introduction of the OSCE is to include an assessment that allows candidates for board certification to demonstrate what they actually “do” in domains relevant to clinical practice. Inherent in this rationale is that the OSCE will capture competencies not well assessed in the current written and oral examinations—competencies that will allow the ABA to judge whether a candidate meets the standards expected for board certification more properly. This special article describes the ABA’s journey from initial conceptualization through first administration of the OSCE, including the format of the OSCE, the process for scenario development, the standardized patient program that supports OSCE administration, examiner training, scoring, and future assessment of reliability, validity, and impact of the OSCE. This information will be beneficial to both those involved in the initial certification process, such as residency graduate candidates and program directors, and others contemplating the use of high-stakes summative OSCE assessments.

ObjectiveThe objective of this study is to compare biologic drug discontinuation rates for older‐ versus younger‐onset rheumatoid arthritis (YORA) because this is a key outcome measure that could impact prescribing practices.MethodsWe performed a retrospective medical record review of all patients who fulfilled the 1987 American College of Rheumatology (ACR) criteria for adult‐onset rheumatoid arthritis (RA) in 1999‐2013 among residents of a geographically defined area, with follow‐up until death, migration, or July 1, 2017. Discontinuation rates were estimated using cumulative incidence adjusted for the competing risk of death.ResultsA total of 240 cases of elderly‐onset rheumatoid arthritis (EORA) and 366 cases of YORA were identified (65% and 73% female, respectively; P = 0.025). Cumulative incidence of biologic initiation was lower among the EORA cohort compared with the YORA cohort (18% vs 33%, respectively, at 10 years after RA incidence; P < 0.001). Among those treated with a biologic, years from RA diagnosis to first biologic treatment was not significantly different between the two groups (P = 0.62). Drug survival of first biologic was 64% at 1 year (95% confidence interval [CI]: 45%‐77%) and 53% at 2 years (95% CI: 33%‐66%) for EORA, compared with 61% at 1 year (95% CI: 50%‐69%) and 45% at 2 years (95% CI: 34%‐53%) for YORA (P = 0.75). Concurrent glucocorticoid use at initiation of first biologic was statistically and significantly associated with a lower risk of discontinuation in EORA (hazard ratio 0.21; 95% CI: 0.08‐0.53) but not in YORA (interaction P = 0.04).ConclusionDrug survival rates of biologic medications did not differ significantly between patients with EORA and YORA.

Abstract Objectives Smoking is a major risk factor for the development of both cardiovascular disease (CVD) and RA and may cause attenuated responses to anti-rheumatic treatments. Our aim was to compare disease activity, CVD risk factors and CVD event rates across smoking status in RA patients. Methods Disease characteristics, CVD risk factors and relevant medications were recorded in RA patients without prior CVD from 10 countries (Norway, UK, Netherlands, USA, Sweden, Greece, South Africa, Spain, Canada and Mexico). Information on CVD events was collected. Adjusted analysis of variance, logistic regression and Cox models were applied to compare RA disease activity (DAS28), CVD risk factors and event rates across categories of smoking status. Results Of the 3311 RA patients (1012 former, 887 current and 1412 never smokers), 235 experienced CVD events during a median follow-up of 3.5 years (interquartile range 2.5–6.1). At enrolment, current smokers were more likely to have moderate or high disease activity compared with former and never smokers (P &lt; 0.001 for both). There was a gradient of worsening CVD risk factor profiles (lipoproteins and blood pressure) from never to former to current smokers. Furthermore, former and never smokers had significantly lower CVD event rates compared with current smokers [hazard ratio 0.70 (95% CI 0.51, 0.95), P = 0.02 and 0.48 (0.34, 0.69), P &lt; 0.001, respectively]. The CVD event rates for former and never smokers were comparable. Conclusion Smoking cessation in patients with RA was associated with lower disease activity and improved lipid profiles and was a predictor of reduced rates of CVD events.

Abstract Objectives Multicentric reticulohistiocytosis (MRH), a rare histiocytic disease that can mimic other rheumatic conditions, may be associated with cancer and other autoimmune disorders. To better understand the disorder and its other associations, we aimed to evaluate clinical correlates and outcomes of all patients with MRH seen at Mayo Clinic, Rochester between 1980 and 2017. Methods A retrospective medical record review was conducted to identify all patients with MRH between 1 January 1980 and 30 April 2017. Results We identified 24 patients with biopsy-proven MRH (58% female, 75% Caucasian, median age at diagnosis 52 years, median follow-up of 2.3 years). All patients had cutaneous and articular involvement; 23 (96%) patients had papulonodular skin lesions (87% periungual and dorsal hand) and seven (30%) mucosal nodules; and 22 (92%) patients had arthralgias, 21 (88%) joint effusions and 13 (54%) synovitis. Most frequently used therapies included corticosteroids, cyclophosphamide, methotrexate and bisphosphonates. Biologics were used in four patients. Nine patients had symptomatic resolution at 1 year and 12 partial improvement. Radiological findings included erosive changes in three (60%) patients and arthritis mutilans in two patients (40%). Twenty-nine per cent of patients had a concomitant autoimmune disease and 25% malignancy including melanoma, endometrial, peritoneal and lung carcinoma. The 5-year survival rate was 85% (95% CI: 74, 100%). Conclusion To our knowledge, this is the largest single-centre series of patients with MRH highlighting the rarity of the condition and an unmet need for treatment options that can allow sustained disease remission. It also highlights the need for a high vigilance for malignancy and autoimmune diseases.