The value of SPECT in the detection of stress injury to the pars interarticularis in patients with low back pain

The medical cost associated with back pain in the United States is considerable and growing. Although the differential diagnosis of back pain is broad, epidemiological studies suggest a correlation between adult and adolescent complaints. Injury of the pars interarticularis is one of the most common identifiable causes of ongoing low back pain in adolescent athletes. It constitutes a spectrum of disease ranging from bone stress to spondylolysis and spondylolisthesis. Bone stress may be the earliest sign of disease. Repetitive bone stress causes bone remodeling and may result in spondylolysis, a non-displaced fracture of the pars interarticularis. A fracture of the pars interarticularis may ultimately become unstable leading to spondylolisthesis. Results in the literature support the use of bone scintigraphy to diagnose bone stress in patients with suspected spondylolysis. Single photon emission computed tomography (SPECT) provides more contrast than planar bone scintigraphy, increases the sensitivity and improves anatomic localization of skeletal lesions without exposing the patient to additional radiation. It also provides an opportunity for better correlation with other imaging modalities, when necessary. As such, the addition of SPECT to standard planar bone scintigraphy can result in a more accurate diagnosis and a better chance for efficient patient care. It is our expectation that by improving our ability to correctly diagnose bone stress in patients with suspected injury of the posterior elements, the long-term cost of managing this condition will be lowered

The Transient Nature of Emergent In-context Learning in Transformers

Transformer neural networks can exhibit a surprising capacity for in-context learning (ICL), despite not being explicitly trained for it. Prior work has provided a deeper understanding of how ICL emerges in transformers, e.g., through the lens of mechanistic interpretability, Bayesian inference, or by examining the distributional properties of training data. However, in each of these cases, ICL is treated largely as a persistent phenomenon; namely, once ICL emerges, it is assumed to persist asymptotically. Here, we show that the emergence of ICL during transformer training is, in fact, often transient. We train transformers on synthetic data designed so that both ICL or in-weights learning (IWL) strategies can lead to correct predictions. We find that ICL first emerges, then disappears and gives way to IWL, all while the training loss decreases, indicating an asymptotic preference for IWL. The transient nature of ICL is observed in transformers across a range of model sizes and datasets, raising the question of how much to “overtrain” transformers when seeking compact, cheaper-to-run models. We find that L2 regularization may offer a path to more persistent ICL that removes the need for early stopping based on ICL-style validation tasks

Two-Minute Peripheral Motion Contrast Threshold Test Predicts Older Drivers’ Collisions and Hazardous Driving in Simulator

Older drivers’ contrast thresholds for low spatial frequency drifting Gabor stimuli at 15 degrees eccentricity were measured with a previously validated 10-minute forced-choice test and a 2-minute increasing contrast detection test (implemented on an iMac and a PC). Older drivers’ contrast thresholds significantly predict collisions, near collisions, hazardous lane excursions, and speeding, during a simulated drive with surprising hazard encounters and highway merging tasks. The 2-minute tests also correlate with each other and with the 10-minute test. The 2-minute tests are potentially suitable for use in an operational driver assessment setting

A systematic review of the use of an expertise-based randomised controlled trial design

Acknowledgements JAC held a Medical Research Council UK methodology (G1002292) fellowship, which supported this research. The Health Services Research Unit, Institute of Applied Health Sciences (University of Aberdeen), is core-funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. Views express are those of the authors and do not necessarily reflect the views of the funders.Peer reviewedPublisher PD

Sixty Years of CA: A Cancer Journal for Clinicians

The first issue of CA: A Cancer Journal for Clinicians was published in November of 1950. On the 60th anniversary of that date, we briefly review several seminal contributions to oncology and cancer control published in our journal during its first decade. CA Cancer J Clin 2010. © 2010 American Cancer Society, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78301/1/20088_ftp.pd

Rheumatoid Factor as a Potentiator of Anti–Citrullinated Protein Antibody–Mediated Inflammation in Rheumatoid Arthritis

Objective. The co-occurrence of rheumatoid factor (RF) and anti–citrullinated protein antibody (ACPA) positivity in rheumatoid arthritis (RA) is well described. However, the mechanisms underlying the potential interaction between these 2 distinct autoantibodies have not been well defined. The aim of this study was to evaluate the epidemiologic and molecular interaction of ACPAs and RF and its association with both disease activity and measures of RA-associated inflammation. Methods. In a cohort of 1,488 US veterans with RA, measures of disease activity and serum levels of cytokines and multiplex ACPAs were compared between the following groups of patients: double-negative (anti–cyclic citrullinated peptide [anti-CCP]-/RF-), anti-CCP+/RF-, anti-CCP-/RF+, or double-positive (anti-CCP+/RF+). Additional studies were performed using an in vitro immune complex (IC) stimulation assay in which macrophages were incubated with ACPA ICs in the presence or absence of monoclonal IgM-RF, and tumor necrosis factor α production measured as a readout of macrophage activation. Results. Compared with the double-negative subgroup (as well as each single-positive subgroup), the double-positive subgroup exhibited higher disease activity as well as higher levels of C-reactive protein and inflammatory cytokines (all P \u3c 0.001). In vitro stimulation of macrophages by ACPA ICs increased cytokine production, and the addition of monoclonal IgM-RF significantly increased macrophage tumor necrosis factor α production (P = 0.003 versus ACPA ICs alone). Conclusion. The combined presence of ACPAs and IgM-RF mediates increased proinflammatory cytokine production in vitro and is associated with increased systemic inflammation and disease activity in RA. Our data suggest that IgM-RF enhances the capacity of ACPA ICs to stimulate macrophage cytokine production, thereby providing a mechanistic link by which RF enhances the pathogenicity of ACPA ICs in RA