Objectives Frontline workers have been a bulwark in the fight against COVID-19, while being subject to major unexpected stressors. These include conflicting news, evolving guidelines, perceived inadequate personal protective equipment, overflow of patients with rising death counts, absence of disaster training, and limitations in the implementation of social distancing. This study investigates the incidence and associated factors of depression, suicidal thoughts, and burnout among physicians during the COVID-19 pandemic. Methods In a cross-sectional survey-based study of resident, fellow, and attending physicians from a tertiary university hospital during the height of the COVID-19 pandemic in New York from April 24 to May 15, 2020, demographics and practice specialty, attending vs. resident/fellow status, call frequency, emotional exhaustion, depersonalization, and depression severity were examined. Results Two hundred twenty-five subjects completed the survey (response rate of 16.3%), with rates of 6.2% depression, 6.6% suicidal ideation, and 19.6% burnout. Depression, suicidal ideation, and burnout were all associated with history of prior depression/anxiety and frequency of on call. Suicidal ideation and burnout were also associated with younger age. There was no difference in rates of depression, suicidal ideation, or burnout between attending and resident physicians. Female physicians reported less work-life balance and more burnout. Conclusions These findings highlight the importance of considering physician mental health during times of peak stress, such as natural or man-made disasters. The prominence of premorbid depression/anxiety as a relevant factor underscores the need to further understand physician mental health and provide early screening and treatment.

Background Existing ultrashort echo time magnetic resonance imaging (UTE MRI) methods require prohibitively long acquisition times (~ 20–40 min) to quantitatively assess the clinically relevant fast decay T2* component in ligaments and tendons. The purpose of this study was to evaluate the feasibility and clinical translatability of a novel abbreviated quantitative UTE MRI paradigm for monitoring graft remodeling after anterior cruciate ligament (ACL) reconstruction. Methods Eight patients who had Graftlink™ hamstring autograft reconstruction were recruited for this prospective study. A 3D double-echo UTE sequence at 3.0 Tesla was performed at 3- and 6-months post-surgery. An abbreviated UTE MRI paradigm was established based on numerical simulations and in vivo validation from healthy knees. This proposed approach was used to assess the T2* for fast decay component ($$ {T}_{2s}^{\ast } $$ T 2 s ∗ ) and bound water signal fraction (fbw) of ACL graft in regions of interest drawn by a radiologist. Results Compared to the conventional bi-exponential model, the abbreviated UTE MRI paradigm achieved low relative estimation bias for $$ {T}_{2s}^{\ast } $$ T 2 s ∗ and fbw over a range of clinically relevant values for ACL grafts. A decrease in $$ {T}_{2s}^{\ast } $$ T 2 s ∗ of the intra-articular graft was observed in 7 of the 8 ACL reconstruction patients from 3- to 6-months (− 0.11 ± 0.16 ms, P = 0.10). Increases in $$ {T}_{2s}^{\ast } $$ T 2 s ∗ and fbw from 3- to 6-months were observed in the tibial intra-bone graft ($$ {\varDelta T}_{2s}^{\ast } $$ ΔT 2 s ∗ : 0.19 ± 0.18 ms, P < 0.05; Δfbw: 4% ± 4%, P < 0.05). Lower $$ {T}_{2s}^{\ast } $$ T 2 s ∗ (− 0.09 ± 0.11 ms, P < 0.05) was observed at 3-months when comparing the intra-bone graft to the graft/bone interface in the femoral tunnel. The same comparisons at the 6-months also yielded relatively lower $$ {T}_{2s}^{\ast } $$ T 2 s ∗ (− 0.09 ± 0.12 ms, P < 0.05). Conclusion The proposed abbreviated 3D UTE MRI paradigm is capable of assessing the ACL graft remodeling process in a clinically translatable acquisition time. Longitudinal changes in $$ {T}_{2s}^{\ast } $$ T 2 s ∗ and fbw of the ACL graft were observed.

Introduction: This study compares rates of depression, suicidal ideation, and burnout among resident/fellow and attending physicians in orthopaedic surgery to other specialties during height/end of the first wave of the coronavirus disease 2019 (COVID-19) pandemic at our institution. Main outcomes and measures included suicidal ideation, Patient Health Questionnaire for Depression (PHQ-9) scores for depression, and 2 single-item measures for emotional exhaustion and depersonalization. This study provides valuable information regarding orthopaedic surgeon mental health during world crises. Methods: This is a cross-sectional survey-based study of resident, fellow, and attending physicians from 26 specialties during and after the first wave of the COVID-19 pandemic at our institution from April 24, 2020 to May 15, 2020. The survey contained 22 items. This includes consent, demographics and general data, 2 single-item questions of emotional exhaustion and depersonalization, and the PHQ-9. Subjects were eligible if they were a resident/fellow or attending physician at our institution. Results: The response rate for the study was 16.31%. Across all specialties rates were 6.2% depression, 19.6% burnout, and 6.6% suicidal ideation. The results for orthopaedic surgeons are as follows: 0% tentative diagnosis of depression, 3.8% suicidal ideation, and 4% burnout. Anesthesiology had the highest rate of depression (14.3%). Internal medicine and other non-surgical specialties had the highest rate of suicidal ideation (10.2%). Orthopaedic surgeons were significantly more likely to achieve work–life balance and experience less burnout than anesthesiologists and pediatricians. Discussion: Depression, suicidal ideation, and burnout continue to affect physicians across all specialties. These issues are amplified in light of crisis. Job satisfaction and rigorous training may be protective factors that allow orthopaedic surgeons to adapt to novel clinical settings under stress when compared to anesthesiologists and pediatricians. Resilience training and stress management strategies should continue to be investigated to better prepare physicians for world crises.

Background Patellar tendon (PT) microstructure integrity and microcirculation status play a crucial role in the progression of tendinopathy and tendon repair. Purpose To assess the feasibility and robustness of stimulated‐echo based diffusion‐weighted MRI with readout‐segmented echo‐planar imaging (ste‐RS‐EPI) for noninvasive assessment of microstructure and microcirculation of human PT. Study Type Prospective. Subjects Fifteen healthy volunteers. Field Strength/Sequence PT diffusion tensor imaging (DTI) and intravoxel incoherent motion (IVIM) were acquired with an ste‐RS‐EPI protocol on a 3T MRI scanner. Assessment Subjects were positioned with their PT at the magic angle. DTI‐derived parameters including axial diffusivity (AD), radial diffusivity (RD), mean diffusivity (MD), and fractional anisotropy (FA) were estimated with b‐values of 0 and 800 s/mm2 and 12 diffusion directions. IVIM‐derived parameters, f p, D* × f p, V b, and D* × V b were assessed in the central‐third and the outer‐two thirds of the PT with b‐values of 0, 20, 30, 60, 80, 120, 200, 400, and 600 s/mm2 in three orthogonal directions. Statistical Tests Paired t‐tests were used to evaluate differences in IVIM parameters between the central‐third and outer‐two thirds regions of the patellar tendon. Paired t‐tests and within‐subject coefficient of variation were used to assess the intra‐ and intersession reproducibility of PT DTI and IVIM parameters. Results DTI parameters for healthy PT were 1.54 ± 0.09 × 10‐3 mm2/s, 1.01 ± 0.05 × 10‐3 mm2/s, 1.18 ± 0.06 × 10‐3 mm2/s, and 0.30 ± 0.04 for AD, RD, MD, and FA, respectively. Significantly higher (P < 0.05) IVIM parameters f p and D* × f p were observed in the outer‐two thirds (6.1% ± 2.4% and 95.2 ± 49.6, respectively) compared with the central‐third (3.8% ± 2.3% and 48.6 ± 35.2, respectively) of the PT. Data Conclusion Diffusion MRI of PT with an ste‐RS‐EPI protocol is clinically feasible. Both DTI‐ and IVIM‐derived parameters of the PT demonstrated good test–retest reproducibility and interrater reliability. Level of Evidence: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2020;51:780–790.