Background: Computer-aided methods have been widely applied to diagnose lesions detected on breast MRI, but fullyautomatic diagnosis using deep learning is rarely reported. Purpose: To evaluate the diagnostic accuracy of mass lesions using region of interest (ROI)-based, radiomics and deeplearning methods, by taking peritumor tissues into consideration. Study Type: Retrospective. Population: In all, 133 patients with histologically confirmed 91 malignant and 62 benign mass lesions for training (74 patients with 48 malignant and 26 benign lesions for testing). Field Strength/Sequence: 3T, using the volume imaging for breast assessment (VIBRANT) dynamic contrast-enhanced (DCE) sequence. Assessment: 3D tumor segmentation was done automatically by using fuzzy-C-means algorithm with connectedcomponent labeling. A total of 99 texture and histogram parameters were calculated for each case, and 15 were selected using random forest to build a radiomics model. Deep learning was implemented using ResNet50, evaluated with 10-fold crossvalidation. The tumor alone, smallest bounding box, and 1.2, 1.5, 2.0 times enlarged boxes were used as inputs. Statistical Tests: The malignancy probability was calculated using each model, and the threshold of 0.5 was used to make a diagnosis. Results: In the training dataset, the diagnostic accuracy was 76% using three ROI-based parameters, 84% using the radiomics model, and 86% using ROI + radiomics model. In deep learning using the per-slice basis, the area under the receiver operating characteristic (ROC) was comparable for tumor alone, smallest and 1.2 times box (AUC = 0.97-0.99), which were significantly higher than 1.5 and 2.0 times box (AUC = 0.86 and 0.71, respectively). For per-lesion diagnosis, the highest accuracy of 91% was achieved when using the smallest bounding box, and that decreased to 84% for tumor alone and 1.2 times box, and further to 73% for 1.5 times box and 69% for 2.0 times box. In the independent testing dataset, the perlesion diagnostic accuracy was also the highest when using the smallest bounding box, 89%. Data Conclusion: Deep learning using ResNet50 achieved a high diagnostic accuracy. Using the smallest bounding box containing proximal peritumor tissue as input had higher accuracy compared to using tumor alone or larger boxes. Level of Evidence: 3 Technical Efficacy: Stage 2

The extant literature demonstrates that exposure to threat almost always increases support for political conservatism. But can threat increase the support for political liberalism? The current article provides evidence that threat can increase the aspects of political liberalism. Across three experiments, we find that experimentally manipulated threats to health-care access (Experiment 1, N = 558), pollution (Experiment 2, N = 184), and corporate misconduct (Experiment 3, N = 225) produced increased support for components of liberalism. These findings fill a notable gap in the literature, broadening larger theoretical discussions of threat as a psychological construct and current understandings of experimentally manipulated attitudinal change.

Nerve reconstruction for upper brachial plexus injury consists of nerve repair and/or transfer. Current literature lacks evidence supporting a preferred surgical treatment for adults with such injury involving shoulder and elbow function. We systematically reviewed the literature published from January 1990 to February 2011 using multiple databases to search the following: brachial plexus and graft, repair, reconstruction, nerve transfer, neurotization. Of 1360 articles initially identified, 33 were included in analysis, with 23 nerve transfer (399 patients), 6 nerve repair (99 patients), and 4 nerve transfer + proximal repair (117 patients) citations (mean preoperative interval, 6 ± 1.9 months). For shoulder abduction, no significant difference was found in the rates ratio (comparative probabilities of event occurrence) among the 3 methods to achieve a Medical Research Council (MRC) scale score of 3 or higher or a score of 4 or higher. For elbow flexion, the rates ratio for nerve transfer vs nerve repair to achieve an MRC scale score of 3 was 1.46 (P = .03); for nerve transfer vs nerve transfer + proximal repair to achieve an MRC scale score of 3 was 1.45 (P = .02) and an MRC scale score of 4 was 1.47 (P = .05). Therefore, for elbow flexion recovery, nerve transfer is somewhat more effective than nerve repair; however, no particular reconstruction strategy was found to be superior to recover shoulder abduction. When considering nerve reconstruction strategies, our findings do not support the sole use of nerve transfer in upper brachial plexus injury without operative exploration to provide a clear understanding of the pathoanatomy. Supraclavicular brachial plexus exploration plays an important role in developing individual surgical strategies, and nerve repair (when donor stumps are available) should remain the standard for treatment of upper brachial plexus injury except in isolated cases solely lacking elbow flexion.

Genome‐wide association studies (GWAS) of alcohol dependence (AD) have reliably identified variation within alcohol metabolizing genes (eg, ADH1B) but have inconsistently located other signals, which may be partially attributable to symptom heterogeneity underlying the disorder. We conducted GWAS of DSM‐IV AD (primary analysis), DSM‐IV AD criterion count (secondary analysis), and individual dependence criteria (tertiary analysis) among 7418 (1121 families) European American (EA) individuals from the Collaborative Study on the Genetics of Alcoholism (COGA). Trans‐ancestral meta‐analyses combined these results with data from 3175 (585 families) African‐American (AA) individuals from COGA. In the EA GWAS, three loci were genome‐wide significant: rs1229984 in ADH1B for AD criterion count (P = 4.16E−11) and Desire to cut drinking (P = 1.21E−11); rs188227250 (chromosome 8, Drinking more than intended, P = 6.72E−09); rs1912461 (chromosome 15, Time spent drinking, P = 1.77E−08). In the trans‐ancestral meta‐analysis, rs1229984 was associated with multiple phenotypes and two additional loci were genome‐wide significant: rs61826952 (chromosome 1, DSM‐IV AD, P = 8.42E−11); rs7597960 (chromosome 2, Time spent drinking, P = 1.22E−08). Associations with rs1229984 and rs18822750 were replicated in independent datasets. Polygenic risk scores derived from the EA GWAS of AD predicted AD in two EA datasets (P < .01; 0.61%‐1.82% of variance). Identified novel variants (ie, rs1912461, rs61826952) were associated with differential central evoked theta power (loss − gain; P = .0037) and reward‐related ventral striatum reactivity (P = .008), respectively. This study suggests that studying individual criteria may unveil new insights into the genetic etiology of AD liability.

Object The rate of neonatal brachial plexus palsy (NBPP) remains 0.4%–4% despite improvements in perinatal care. Among affected children, the extent of brachial plexus palsy differs greatly, as does the prognosis. Controversial elements in management include indications and timing of nerve repair as well as type of reconstruction in patients in whom function will ultimately not be recovered without surgical intervention. Differentiating preganglionic (avulsion) from postganglionic (rupture) lesions is critical because preganglionic lesions cannot spontaneously recover motor function. Distinguishing between these lesions at initial presentation based on clinical examination alone can be difficult in infants. The purpose of the present study was to determine the sensitivity of preoperative electrodiagnostic studies (EDSs) and CT myelography (CTM) in determining the presence of nerve root rupture and avulsions in infants with NBPP. Methods After receiving institutional review board approval, the authors conducted a retrospective review of patients referred to the Neonatal Brachial Plexus Program between 2007 and 2010. Inclusion criteria included children who underwent brachial plexus exploration following preoperative EDSs and CTM. The CTM scans were interpreted by a staff neuroradiologist, EDSs were conducted by a single physiatrist, and intraoperative findings were recorded by the operating neurosurgeon. The findings from the preoperative EDSs and CTM were then compared with intraoperative findings. The sensitivities and 95% confidence intervals were determined to evaluate performance accuracy of each preoperative measure. Results Twenty-one patients (8 male amd 13 female) met inclusion criteria for this study. The sensitivity of EDSs and CTM for detecting a postganglionic rupture was 92.8% (CI 0.841–0.969) and 58.3% (CI 0.420–0.729), respectively. The sensitivity for EDSs and CTM for preganglionic nerve root avulsion was 27.8% (CI 0.125–0.509) and 72.2% (CI 0.491–0.875), respectively. In cases in which both CTM and EDSs gave concordant results, the sensitivity for both modalities combined was 50.0% (CI 0.237–0.763) for avulsion and 80.8% (CI 0.621–0.915) for rupture. Overall, EDSs were most useful in identifying ruptures, particularly in the upper plexus, whereas CTM was most sensitive in identifying avulsions in the lower plexus. Conclusions Knowledge of the spinal nerve integrity is critical for early management of patients with NBPP. Surgical management, in the form of nerve repair/reconstruction, and optimal prognostication of NBPP depend on the accurate diagnosis of the level and type of lesion. Both EDSs and CTM scans must always be interpreted in the context of a comprehensive evaluation of the patient. They provide supplemental information (in addition to the physical examination) for early detection of nerve root rupture and avulsion injuries, aiding surgical decision making and preoperative planning for NBPP. Continued advances in imaging, EDSs, and microsurgical nerve repair techniques will allow surgeons to achieve greater success for functional recovery in management of NBPP.

Introduction In academia, women remain underrepresented. Our purpose was to examine differences in faculty position and professional satisfaction among academic physicians by gender. Methods From 2008–2012, academic faculty members at a single institution were surveyed (2008 n=737; 2010 n=1151; 2012 n=971). Outcomes included position, choice of position, professional satisfaction, and the reasons for leaving. Logistic regression was performed to compare aspects of professional satisfaction by gender. Results Men more often held tenure track positions compared with women (2008: 45% vs. 20%; 2010: 47% vs. 20%, 2012: 49% vs. 20%, p<0.001). Women were more likely to engage in only clinical activities compared with men (2008: 31% vs. 18%, 2010: 28% vs. 14%; 2012: 33% vs. 13%, p<0.001), and less likely to participate in research. Women chose tracks to accommodate work-life balance (2008: OR=1.9 (1.29 – 2.76); 2010: OR: 2.0 (1.38 – 2.76); 2012: OR: 2.1 (1.40 – 3.00)), and but not for the opportunity of tenure (2008: OR=0.4 (0.23 – 0.75); 2010: OR=0.5 (0.35–0.85); 2012: OR=0.5 (0.29–0.76) compared with men. Men reported higher professional satisfaction compared with women (2008: 5.7 vs. 5.4, p<0.009; 2012: 5.3 vs. 5.0, p<0.03). Men were more likely to leave due leadership opportunities (14.4% vs. 9.2%, p<0.03) and compensation (14.2% vs. 9.2%, p<0.03) compared with women. Conclusions Women are less satisfied in academic practice compared with men, and make choices to accommodate the demands of their work-life balance. Given the increasing pressures of academic practice, efforts to align work-life balance can improve faculty satisfaction and retention.

Background Short-term results after proximal interphalangeal joint (PIPJ) arthroplasty with pyrolytic carbon (pyrocarbon) implant have shown that this implant suffers from high rates of complications; however patient satisfaction is high. The aim of this study is to evaluate the effectiveness of the pyrocarbon implant for use in PIPJ at a minimum 2 years follow-up. Methods Thirteen consecutive candidates who underwent 21 PIPJ arthroplasty with pyrocarbon implant were evaluated prospectively. Functional measurements and the Michigan Hand Outcomes Questionnaire (MHQ) were administered preoperatively and at 12-months, and intermediate-term (>2 years) postoperatively. Preoperative and intermediate-term mean data for all functional measures and MHQ scores were compared. Results A total of 13 patients were treated in this study with a mean follow-up of 44 months. Grip strength, key pinch strength, and active arc of motion demonstrated no statistical difference between pre-operative and intermediate-term assessment. All domains of the MHQ showed improved large effect size at intermediate-term follow-up, especially Pain and Satisfaction. There were 10 complications in 9 joints (42.9% complication rate). Patients without complications had better functional outcomes, however there were no statistical differences in MHQ scores between patients with and without complications except for Pain (p=0.04). Conclusions PIPJ arthroplasty with pyrocarbon implant seems to be an effective way of reducing pain without sacrificing active arc of motion. Despite a high rate of complications, patients generally were satisfied, especially with pain relief. Additionally, complications do not affect patients’ satisfaction even if hand function was affected. Further decision-making analysis to compare arthroplasty and fusion for each finger may help surgeons to select the appropriate operative procedures. Levels of Evidence Therapeutic IV

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