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Key Points Question Are pediatric thyroid nodules amenable to cancer prediction by genomic classification? Findings In this retrospective study of 95 pediatric patients with thyroid nodules, surgical samples underwent next-generation sequencing and genomic classification. Testing defined the unique molecular landscape of pediatric thyroid nodules (which, as opposed to adults, comprised more frequent gene fusions and DICER1 variants) and identified a sensitivity of 96% and specificity of 78% regarding cancer detection. Meaning The study results suggest that although the molecular landscape of pediatric thyroid nodules is different than in adults, it remains amenable to multigene genomic classification, which may help prevent potentially unnecessary diagnostic surgeries.

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Objective Incomplete and static reaction picklists in the allergy module led to free-text and missing entries that inhibit the clinical decision support intended to prevent adverse drug reactions. We developed a novel, data-driven, “dynamic” reaction picklist to improve allergy documentation in the electronic health record (EHR). Materials and Methods We split 3 decades of allergy entries in the EHR of a large Massachusetts healthcare system into development and validation datasets. We consolidated duplicate allergens and those with the same ingredients or allergen groups. We created a reaction value set via expert review of a previously developed value set and then applied natural language processing to reconcile reactions from structured and free-text entries. Three association rule-mining measures were used to develop a comprehensive reaction picklist dynamically ranked by allergen. The dynamic picklist was assessed using recall at top k suggested reactions, comparing performance to the static picklist. Results The modified reaction value set contained 490 reaction concepts. Among 4 234 327 allergy entries collected, 7463 unique consolidated allergens and 469 unique reactions were identified. Of the 3 dynamic reaction picklists developed, the 1 with the optimal ranking achieved recalls of 0.632, 0.763, and 0.822 at the top 5, 10, and 15, respectively, significantly outperforming the static reaction picklist ranked by reaction frequency. Conclusion The dynamic reaction picklist developed using EHR data and a statistical measure was superior to the static picklist and suggested proper reactions for allergy documentation. Further studies might evaluate the usability and impact on allergy documentation in the EHR.

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Motor deficit is among the most debilitating aspects of injury to the central nervous system. Despite ongoing progress in brain-machine interface (BMI) development and in the functional electrical stimulation of muscles and nerves, little is understood about how neural signals in the brain may be used to potentially control movement in one’s own unconstrained paralyzed limb. We recorded from high-density electrocorticography (ECoG) electrode arrays in the ventral premotor cortex (PMv) of a rhesus macaque and used real-time motion tracking techniques to correlate spatial-temporal changes in neural activity with arm movements made towards objects in three-dimensional space at millisecond precision. We found that neural activity from a small number of electrodes within the PMv can be used to accurately predict reach-return movement onset and directionality. Also, whereas higher gamma frequency field activity was more predictive about movement direction during performance, mid-band (beta and low gamma) activity was more predictive of movement prior to onset. We speculate these dual spatiotemporal signals may be used to optimize both planning and execution of movement during natural reaching, with prospective relevance to the future development of neural prosthetics aimed at restoring motor control over one’s own paralyzed limb.

The production of portland cement-the key ingredient in concrete-generates a significant amount of carbon dioxide. However, due to its incredible versatility, availability, and relatively low cost, concrete is the most consumed synthetic material on the planet. One method of reducing concrete's contribution to greenhouse-gas emissions is the use of fly ash to replace a significant amount of the cement. This paper compares two experimental studies that were conducted to investigate the shear strength of full-scale beams constructed with both high-volume fly ash concrete (HVFAC)-concrete with at least 50% of the cement replaced with fly ash-and conventional concrete (CC). The primary difference between the two studies involved the amount of cementitious material, with one mix having a relatively high-total cementitious content [502 kg=m 3 (850 lb=yd 3)] and the other mix having a relatively low-total cementitious content [337 kg=m 3 (570 lb=yd 3)]. Both HVFAC mixes used a 70% mass replacement of portland cement with Class C fly ash. Each of these experimental programs consisted of 16 beams-eight constructed from HVFAC and eight constructed from CC-with three different longitudinal reinforcement ratios. The beams were tested under a simply supported four-point-loading condition. The experimental shear strengths of the beams were compared with both the shear provisions of selected standards (United States, Australia, Canada, Europe, and Japan) and a shear database of CC specimens. This comparison indicates that the HVFAC beams possess superior shear strength compared with the CC beams.