Comparison of Commercial AI Software Performance for Radiograph Lung Nodule Detection and Bone Age Prediction.

Background Multiple commercial artificial intelligence (AI) products exist for assessing radiographs; however, comparable performance data for these algorithms are limited. Purpose To perform an independent, stand-alone validation of commercially available AI products for bone age prediction based on hand radiographs and lung nodule detection on chest radiographs. Materials and Methods This retrospective study was carried out as part of Project AIR. Nine of 17 eligible AI products were validated on data from seven Dutch hospitals. For bone age prediction, the root mean square error (RMSE) and Pearson correlation coefficient were computed. The reference standard was set by three to five expert readers. For lung nodule detection, the area under the receiver operating characteristic curve (AUC) was computed. The reference standard was set by a chest radiologist based on CT. Randomized subsets of hand (n = 95) and chest (n = 140) radiographs were read by 14 and 17 human readers, respectively, with varying experience. Results Two bone age prediction algorithms were tested on hand radiographs (from January 2017 to January 2022) in 326 patients (mean age, 10 years ± 4 [SD]; 173 female patients) and correlated strongly with the reference standard (r = 0.99; P < .001 for both). No difference in RMSE was observed between algorithms (0.63 years [95% CI: 0.58, 0.69] and 0.57 years [95% CI: 0.52, 0.61]) and readers (0.68 years [95% CI: 0.64, 0.73]). Seven lung nodule detection algorithms were validated on chest radiographs (from January 2012 to May 2022) in 386 patients (mean age, 64 years ± 11; 223 male patients). Compared with readers (mean AUC, 0.81 [95% CI: 0.77, 0.85]), four algorithms performed better (AUC range, 0.86-0.93; P value range, <.001 to .04). Conclusions Compared with human readers, four AI algorithms for detecting lung nodules on chest radiographs showed improved performance, whereas the remaining algorithms tested showed no evidence of a difference in performance. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Omoumi and Richiardi in this issue.

Clinical use of artificial intelligence products for radiology in the Netherlands between 2020 and 2022.

OBJECTIVES: To map the clinical use of CE-marked artificial intelligence (AI)-based software in radiology departments in the Netherlands (n = 69) between 2020 and 2022. MATERIALS AND METHODS: Our AI network (one radiologist or AI representative per Dutch hospital organization) received a questionnaire each spring from 2020 to 2022 about AI product usage, financing, and obstacles to adoption. Products that were not listed on www.AIforRadiology.com by July 2022 were excluded from the analysis. RESULTS: The number of respondents was 43 in 2020, 36 in 2021, and 33 in 2022. The number of departments using AI has been growing steadily (2020: 14, 2021: 19, 2022: 23). The diversity (2020: 7, 2021: 18, 2022: 34) and the number of total implementations (2020: 19, 2021: 38, 2022: 68) has rapidly increased. Seven implementations were discontinued in 2022. Four hospital organizations said to use an AI platform or marketplace for the deployment of AI solutions. AI is mostly used to support chest CT (17), neuro CT (17), and musculoskeletal radiograph (12) analysis. The budget for AI was reserved in 13 of the responding centers in both 2021 and 2022. The most important obstacles to the adoption of AI remained costs and IT integration. Of the respondents, 28% stated that the implemented AI products realized health improvement and 32% assumed both health improvement and cost savings. CONCLUSION: The adoption of AI products in radiology departments in the Netherlands is showing common signs of a developing market. The major obstacles to reaching widespread adoption are a lack of financial resources and IT integration difficulties. CLINICAL RELEVANCE STATEMENT: The clinical impact of AI starts with its adoption in daily clinical practice. Increased transparency around AI products being adopted, implementation obstacles, and impact may inspire increased collaboration and improved decision-making around the implementation and financing of AI products. KEY POINTS: • The adoption of artificial intelligence products for radiology has steadily increased since 2020 to at least a third of the centers using AI in clinical practice in the Netherlands in 2022. • The main areas in which artificial intelligence products are used are lung nodule detection on CT, aided stroke diagnosis, and bone age prediction. • The majority of respondents experienced added value (decreased costs and/or improved outcomes) from using artificial intelligence-based software; however, major obstacles to adoption remain the costs and IT-related difficulties.

Mode-coupling theory of lattice dynamics for classical and quantum crystals.

The dynamical properties of nuclei, carried by the concept of phonon quasiparticles , are central to the field of condensed matter. While the harmonic approximation can reproduce a number of properties observed in real crystals, the inclusion of anharmonicity in lattice dynamics is essential to accurately predict properties such as heat transport or thermal expansion. For highly anharmonic systems, non-perturbative approaches are needed, which result in renormalized theories of lattice dynamics. In this article, we apply the Mori-Zwanzig projector formalism to derive an exact generalized Langevin equation describing the quantum dynamics of nuclei in a crystal. By projecting this equation on quasiparticles in reciprocal space, and with results from linear response theory, we obtain a formulation of vibrational spectra that fully accounts for the anharmonicity. Using a mode-coupling approach, we construct a systematic perturbative expansion in which each new order is built to minimize the following ones. With a truncation to the lowest order, we show how to obtain a set of self-consistent equations that can describe the lineshapes of quasiparticles. The only inputs needed for the resulting set of equations are the static Kubo correlation functions, which can be computed using (fully quantum) path-integral molecular dynamics or approximated with (classical or ab initio) molecular dynamics. We illustrate the theory with an application on fcc 4He, an archetypal quantum crystal with very strong anharmonicity.

Diversity-oriented synthesis encoded by deoxyoligonucleotides.

Diversity-oriented synthesis (DOS) is a powerful strategy to prepare molecules with underrepresented features in commercial screening collections, resulting in the elucidation of novel biological mechanisms. In parallel to the development of DOS, DNA-encoded libraries (DELs) have emerged as an effective, efficient screening strategy to identify protein binders. Despite recent advancements in this field, most DEL syntheses are limited by the presence of sensitive DNA-based constructs. Here, we describe the design, synthesis, and validation experiments performed for a 3.7 million-member DEL, generated using diverse skeleton architectures with varying exit vectors and derived from DOS, to achieve structural diversity beyond what is possible by varying appendages alone. We also show screening results for three diverse protein targets. We will make this DEL available to the academic scientific community to increase access to novel structural features and accelerate early-phase drug discovery.

A pre-time-zero spatiotemporal microscopy technique for the ultrasensitive determination of the thermal diffusivity of thin films.

Diffusion is one of the most ubiquitous transport phenomena in nature. Experimentally, it can be tracked by following point spreading in space and time. Here, we introduce a spatiotemporal pump-probe microscopy technique that exploits the residual spatial temperature profile obtained through the transient reflectivity when probe pulses arrive before pump pulses. This corresponds to an effective pump-probe time delay of 13 ns, determined by the repetition rate of our laser system (76 MHz). This pre-time-zero technique enables probing the diffusion of long-lived excitations created by previous pump pulses with nanometer accuracy and is particularly powerful for following in-plane heat diffusion in thin films. The particular advantage of this technique is that it enables quantifying thermal transport without requiring any material input parameters or strong heating. We demonstrate the direct determination of the thermal diffusivities of films with a thickness of around 15 nm, consisting of the layered materials MoSe2 (0.18 cm2/s), WSe2 (0.20 cm2/s), MoS2 (0.35 cm2/s), and WS2 (0.59 cm2/s). This technique paves the way for observing nanoscale thermal transport phenomena and tracking diffusion of a broad range of species.

Facing cyberthreats in a crisis and post-crisis era: Rethinking security services response strategy.

The recent years have witnessed two major events that have deeply impacted cybersecurity threats. First, the COVID-19 pandemic has drastically increased our dependence upon technology. From individuals to corporations and governments, the overwhelming majority of our activities moved online. As the proportion of human activities performed online is reaching new peaks, cybersecurity becomes a problem of national security. Second, the Russia-Ukraine war is giving us a glimpse of what cyberthreats may look like in future cyberconflicts. From data integrity to identity thievery, and from industrial espionage to hostile manoeuvres from foreign powers, cyberthreats have never been that numerous and diverse. Due to the increase of the magnitude, of the diversity, and of the complexity of cyberthreats, the current security strategies used to face cybercriminality won't be sufficient in the post-crisis era. Therefore, governments need to rethink globally their national security services response strategy. This paper analyses how this new context has impacted cybersecurity for individuals, corporations, and governments, and emphasis the need to reposition the economical identity of the individuals at the center of security response. We propose strategies to optimize law enforcement response from police to counterintelligence, notably through formation, prevention, and interaction with cybercriminality. We then discuss the possibilities to optimize the articulation of the different levels of security response and expertise, by emphasizing the need for coordination between security services, and by proposing strategies to include non-institutional players.

History of Previous Midlife Estradiol Treatment Permanently Alters Interactions of Brain Insulin-like Growth Factor-1 Signaling and Hippocampal Estrogen Synthesis to Enhance Cognitive Aging in a Rat Model of Menopause.

Across species, including humans, elevated levels of brain estrogen receptor (ER) α are associated with enhanced cognitive aging, even in the absence of circulating estrogens. In rodents, short-term estrogen treatment, such as that commonly used in the menopausal transition, results in long-term increases in ERα levels in the hippocampus, leading to enhanced memory long after termination of estrogen treatment. However, mechanisms by which increased levels of brain ERα enhances cognitive aging remain unclear. Here we demonstrate in aging female rats that insulin-like growth factor-1 (IGF-1), which can activate ER via ligand-independent mechanisms, requires concomitant synthesis of brain-derived neuroestrogens to phosphorylate ERα via MAPK signaling, ultimately resulting in enhanced memory. In a rat model of menopause involving long-term ovarian hormone deprivation, hippocampal neuroestrogen activity decreases, altering IGF-1 activity and resulting in impaired memory. However, this process is reversed by short-term estradiol treatment. Forty days of estradiol exposure following ovariectomy results in maintenance of neuroestrogen levels that persist beyond the period of hormone treatment, allowing for continued interactions between IGF-1 and neuroestrogen signaling, elevated levels of hippocampal ERα, and ultimately enhanced memory. Collectively, results demonstrate that short-term estradiol use following loss of ovarian function has long-lasting effects on hippocampal function and memory by dynamically regulating cellular mechanisms that promote activity of ERα in the absence of circulating estrogens. Translational impacts of these findings suggest lasting cognitive benefits of short-term estrogen use near menopause and highlight the importance of hippocampal ERα, independent from the role of circulating estrogens, in regulating memory in aging females.SIGNIFICANCE STATEMENT Declines in ovarian hormones following menopause coincide with increased risk of cognitive decline. Because of potential health risks, current recommendations are that menopausal estrogen therapy be limited to a few years. Long-term consequences for the brain and memory of this short-term midlife estrogen therapy are unclear. Here, in a rodent model of menopause, we determined mechanisms by which short-term midlife estrogen exposure can enhance hippocampal function and memory with cognitive benefits and molecular changes enduring long after termination of estrogen exposure. Our model indicates long-lasting benefits of maintaining hippocampal estrogen receptor function in the absence of ongoing estrogen exposure and suggests potential strategies for combating age-related cognitive decline.

Physical Activity as a Clinical Tool against Depression: Opportunities and Challenges.

Depression is a major public health issue in numerous countries, with around 300 million people worldwide suffering from it. Typically, depressed patients are treated with antidepressants or psychological therapy or a combination of both. However, there are some limitations associated with these therapies and as a result, over the past decades a number of alternative or complementary therapies have been developed. Exercise is one such option that is supported by published extensive basic and clinical research data. The aim of this review was to examine the beneficial effects of exercise in depression. Physical activity and exercise have been shown to be effective in treating mild-to-moderate depression and in reducing mortality and symptoms of major depression. However, physical activity and exercise are still underused in clinical practice. This review attempts to propose a framework to help clinicians in their decision-making process, how to incorporate physical activity in their toolkit of potential therapeutic responses for depressed patients. We first summarize the interactions between depression and physical activities, with a particular focus on the potential antidepressant physiological effects of physical activity. We then identify some of the barriers blocking physical activity from being used to fight depression. Finally, we present several perspectives and ideas that can help in optimizing mitigation strategies to challenge these barriers, including actions on physical activity representations, ways to increase the accessibility of physical activity, and the potential of technology to help both clinicians and patients.

Tourniquet Does Not Affect Long-term Outcomes in Minor Hand Surgery: A Randomized Controlled Trial.

Surgeons often prefer to use a tourniquet during minor procedures, such as carpal tunnel release (CTR) or trigger finger release (TFR). Besides the possible discomfort for the patient, the effect of tourniquet use on long-term results and complications is unknown. Our primary aim was to compare the patient-reported outcomes 1 year after CTR or TFR under local anesthesia with or without tourniquet. Secondary outcomes included satisfaction, sonographically estimated scar tissue thickness after CTR' and postoperative complications. Methods: Between May 2019 and May 2020, 163 patients planned for open CTR or TFR under local anesthesia were included. Before surgery, and at 3, 6, and 12 months postoperatively, Quick Disabilities of the Arm, Shoulder and Hand and Boston Carpal Tunnel questionnaires were administered, and complications were noted. At 6 months postoperatively, an ultrasound was conducted to determine the thickness of scar tissue in the region of median nerve. Results: A total of 142 patients (51 men [38%]) were included. The Quick Disabilities of the Arm, Shoulder and Hand questionnaire and Boston Carpal Tunnel Questionnaire scores improved significantly in both groups during follow-up, wherein most improvements were seen in the first 3 months. No difference in clinical outcome and scar tissue formation was found between the two groups after 12 months. The complication rate was comparable between both groups. Thirty-two (24%) patients had at least one complication, none needed surgical interventions, and no recurrent symptoms were seen. Conclusions: Our study shows similar long-term clinical outcomes, formation of scar tissue, and complication rates for patients undergoing CTR or TFR with or without a tourniquet. Tourniquet usage should be based on shared decision-making.

Mitotic DNA synthesis is caused by transcription-replication conflicts in BRCA2-deficient cells.

Aberrant replication causes cells lacking BRCA2 to enter mitosis with under-replicated DNA, which activates a repair mechanism known as mitotic DNA synthesis (MiDAS). Here, we identify genome-wide the sites where MiDAS reactions occur when BRCA2 is abrogated. High-resolution profiling revealed that these sites are different from MiDAS at aphidicolin-induced common fragile sites in that they map to genomic regions replicating in the early S-phase, which are close to early-firing replication origins, are highly transcribed, and display R-loop-forming potential. Both transcription inhibition in early S-phase and RNaseH1 overexpression reduced MiDAS in BRCA2-deficient cells, indicating that transcription-replication conflicts (TRCs) and R-loops are the source of MiDAS. Importantly, the MiDAS sites identified in BRCA2-deficient cells also represent hotspots for genomic rearrangements in BRCA2-mutated breast tumors. Thus, our work provides a mechanism for how tumor-predisposing BRCA2 inactivation links transcription-induced DNA damage with mitotic DNA repair to fuel the genomic instability characteristic of cancer cells.

Longest sediment flows yet measured show how major rivers connect efficiently to deep sea.

Here we show how major rivers can efficiently connect to the deep-sea, by analysing the longest runout sediment flows (of any type) yet measured in action on Earth. These seafloor turbidity currents originated from the Congo River-mouth, with one flow travelling >1,130 km whilst accelerating from 5.2 to 8.0 m/s. In one year, these turbidity currents eroded 1,338-2,675 [>535-1,070] Mt of sediment from one submarine canyon, equivalent to 19-37 [>7-15] % of annual suspended sediment flux from present-day rivers. It was known earthquakes trigger canyon-flushing flows. We show river-floods also generate canyon-flushing flows, primed by rapid sediment-accumulation at the river-mouth, and sometimes triggered by spring tides weeks to months post-flood. It is demonstrated that strongly erosional turbidity currents self-accelerate, thereby travelling much further, validating a long-proposed theory. These observations explain highly-efficient organic carbon transfer, and have important implications for hazards to seabed cables, or deep-sea impacts of terrestrial climate change.

Tracking a multitude of abilities as they develop.

Recently, the Urnings algorithm (Bolsinova et al., 2022, J. R. Stat. Soc. Ser. C Appl. Statistics, 71, 91) has been proposed that allows for tracking the development of abilities of the learners and the difficulties of the items in adaptive learning systems. It is a simple and scalable algorithm which is suited for large-scale applications in which large streams of data are coming into the system and on-the-fly updating is needed. Compared to alternatives like the Elo rating system and its extensions, the Urnings rating system allows the uncertainty of the ratings to be evaluated and accounts for adaptive item selection which, if not corrected for, may distort the ratings. In this paper we extend the Urnings algorithm to allow for both between-item and within-item multidimensionality. This allows for tracking the development of interrelated abilities both at the individual and the population level. We present formal derivations of the multidimensional Urnings algorithm, illustrate its properties in simulations, and present an application to data from an adaptive learning system for primary school mathematics called Math Garden.

Online Presence of the Funeral Industry: The Example of the Quebec Federation of Funeral Cooperatives.

The digitalization of modern societies has offered new tools for funeral industries to reach the communities they serve, ranging from using technologies in funeral planning, in commemoration of the dead, or to support the bereaved. The COVID-19 pandemic only pushed this need for online presence of the funeral industries further. We explore the digitalization of funeral industries through the example of Quebec (Canada), where many funeral institutions are regrouped under a federation of funeral cooperatives. We analyze how this influences the delivery of funeral services and allows the development of common services answering various needs of the population (e.g., a funding program for youth funerals, an ecological memorialization program, online grief support). Finally, we discuss how the federation's online presence contributes to its mission, and more largely whether it changes the perception of the industry.

First source-to-sink monitoring shows dense head controls sediment flux and runout in turbidity currents.

Until recently, despite being one of the most important sediment transport phenomena on Earth, few direct measurements of turbidity currents existed. Consequently, their structure and evolution were poorly understood, particularly whether they are dense or dilute. Here, we analyze the largest number of turbidity currents monitored to date from source to sink. We show sediment transport and internal flow characteristic evolution as they runout. Observed frontal regions (heads) are fast (>1.5 m/s), thin (<10 m), dense (depth averaged concentrations up to 38%vol), strongly stratified, and dominated by grain-to-grain interactions, or slower (<1 m/s), dilute (<0.01%vol), and well mixed with turbulence supporting sediment. Between these end-members, a transitional flow head exists. Flow bodies are typically thick, slow, dilute, and well mixed. Flows with dense heads stretch and bulk up with dense heads transporting up to 1000 times more sediment than the dilute body. Dense heads can therefore control turbidity current sediment transport and runout into the deep sea.

Spectroscopic signatures of nonpolarons: the case of diamond.

Polarons are quasi-particles made from electrons interacting with vibrations in crystal lattices. They derive their name from the strong electron-vibration polar interactions in ionic systems, that induce spectroscopic and optical signatures of such quasi-particles. In this paper, we focus on diamond, a non-polar crystal with inversion symmetry which nevertheless shows interesting signatures stemming from electron-vibration interactions, better denoted "nonpolaron" signatures in this case. The (non)polaronic effects are produced by short-range crystal fields, while long-range quadrupoles only have a small influence. The corresponding many-body spectral function has a characteristic energy dependence, showing a plateau structure that is similar to but distinct from the satellites observed in the polar Fröhlich case. We determine the temperature-dependent spectral function of diamond by two methods: the standard Dyson-Migdal approach, which calculates electron-phonon interactions within the lowest-order expansion of the self-energy, and the cumulant expansion, which includes higher orders of electron-phonon interactions. The latter corrects the nonpolaron energies and broadening, providing a more realistic spectral function, which we examine in detail for both conduction and valence band edges.

Synthesis of Noraugustamine and Development of an Oxidative Heck/Aza-Wacker Cascade Cyclization.

Radical and transition metal-catalyzed cascade cyclization strategies were investigated with respect to the synthesis of the tetracyclic core of the augustamine-type Amaryllidaceae alkaloids. These studies resulted in the synthesis of noraugustamine and the development of an oxidative Heck/aza-Wacker cascade forming two rings, a C-N bond, and an all-carbon quaternary center in a single step.

Modular Synthesis of Cyclopropane-Fused N-Heterocycles Enabled by Underexplored Diazo Reagents.

Cyclopropane-fused N-heterocycles are featured in various biologically active compounds and represent attractive scaffolds in medicinal chemistry. However, synthesis routes to access structurally and functionally diverse cyclopropane-fused N-heterocycles remain underexplored. Leveraging novel α-diazo acylating agents, we report a general approach for the direct and modular synthesis of cyclopropane-fused lactams from unsaturated amines. The operationally simple transformation, which proceeds through successive acylation, (3+2) cycloaddition and fragmentation, tolerates a broad range of functional groups and yields a wide spectrum of complex molecular scaffolds, including fused, bridged and spiro ring systems. We demonstrate the utility of this transformation in the concise syntheses of therapeutic agents milnaciprane and amitifadine.

Unraveling Heat Transport and Dissipation in Suspended MoSe2 from Bulk to Monolayer.

Understanding heat flow in layered transition metal dichalcogenide (TMD) crystals is crucial for applications exploiting these materials. Despite significant efforts, several basic thermal transport properties of TMDs are currently not well understood, in particular how transport is affected by material thickness and the material's environment. This combined experimental-theoretical study establishes a unifying physical picture of the intrinsic lattice thermal conductivity of the representative TMD MoSe2 . Thermal conductivity measurements using Raman thermometry on a large set of clean, crystalline, suspended crystals with systematically varied thickness are combined with ab initio simulations with phonons at finite temperature. The results show that phonon dispersions and lifetimes change strongly with thickness, yet the thinnest TMD films exhibit an in-plane thermal conductivity that is only marginally smaller than that of bulk crystals. This is the result of compensating phonon contributions, in particular heat-carrying modes around ≈0.1 THz in (sub)nanometer thin films, with a surprisingly long mean free path of several micrometers. This behavior arises directly from the layered nature of the material. Furthermore, out-of-plane heat dissipation to air molecules is remarkably efficient, in particular for the thinnest crystals, increasing the apparent thermal conductivity of monolayer MoSe2 by an order of magnitude. These results are crucial for the design of (flexible) TMD-based (opto-)electronic applications.

Case 298: Skeletal Fluorosis Secondary to Huffing.

History A 37-year-old man from the United States presented with a 1-year history of neck pain and stiffness that had been unsuccessfully treated with manipulative therapy by a chiropractor at another institution. Past medical history was remarkable only for marijuana and air duster abuse. He denied use of any prescription medications. Physical examination was notable for markedly reduced range of motion of the cervical spine. Laboratory work-up revealed an elevated alkaline phosphatase level (302 U/L [5.0 µkat/L]; normal range, 40-100 U/L [0.7-1.67 µkat/L]), but all other laboratory findings, including complete blood count, renal function, liver function, vitamin A level, serum protein electrophoresis, and hepatitis C antibodies were within normal limits. Cervical spine radiography was performed, followed by MRI. Subsequently, a full skeletal survey was ordered. Included are representative radiographs of the pelvis, left forearm, and distal right leg with ankle.