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Bridging the Gap: Advancing AI in Diagnostic Radiology from Concept to Clinical Integration
No full textArtificial intelligence (AI) is rapidly reshaping diagnostic radiology, driving transformations in clinical workflows while raising critical questions about regulation, data integrity, and clinical autonomy. As imaging modalities and patient demographics evolve, AI models must be continuously updated to remain both accurate and safe. González et al. (2024) highlight how shifts in image characteristics necessitate regular model re-training—a process historically hampered by cumbersome re-approval requirements. Recent regulatory reforms, such as the European Artificial Intelligence Act and the FDA’s Predetermined Change Control Plan, now offer streamlined pathways for dynamic updates, ensuring that obsolete systems are phased out more efficiently. In tandem with these regulatory advances, technological platforms are emerging to lower the barriers to AI adoption. The HOPPR Medical-Grade Platform, as described by Slavkova et al. (2024), provides the computational infrastructure, foundation models, and extensive, high-quality imaging datasets needed to develop and fine-tune large vision language models (LVLMs) for clinical use. This integrated approach not only expedites development but also embeds rigorous quality management systems, enabling AI tools to be seamlessly integrated into established radiological workflows. Standardization is emerging as another key factor in the transition from experimental to clinical AI. Zhang et al. (2024) introduce ReXrank—a public leaderboard that benchmarks AI-powered radiology report generation using multiple datasets and diverse evaluation metrics. By setting consistent performance standards, such initiatives help ensure that AI systems are robust and reliable across varied clinical settings. The clinical promise of AI is underscored by advancements in specific applications. In chest imaging, for example, Bramley et al. (2024) demonstrate that while individual AI findings on chest X-rays correlate with lung cancer, a composite prioritization strategy markedly improves detection rates, offering a more effective triage system for busy clinical environments. Similarly, the work of Loper and Makary (2024) in abdominal imaging illustrates how AI can enhance diagnostic precision across a spectrum of pathologies— from hepatobiliary to pancreatic disorders—despite ongoing challenges related to data heterogeneity. Importantly, AI should serve as an aid to radiologists rather than a replacement. Solomon et al. (2024) propose a “2-factor retrieval” system that empowers clinicians to verify AI predictions by retrieving similar imaging cases, thereby bolstering diagnostic accuracy while preserving professional autonomy. Complementing these technical advances, community-driven initiatives (Gupta et al. 2024) emphasize the need for standardized data pipelines and collaborative frameworks to facilitate the real-world deployment of AI. At the heart of this evolution is the radiologist’s expanding role. As Park et al. (2023) assert, radiologists must develop an understanding of AI research to effectively evaluate and guide the integration of these technologies into practice. Equally, patient perspectives— highlighted by Hemphill et al. (2024)—stress that transparency, accountability, and combined human–AI interpretation are essential for fostering public trust. Together, these developments illustrate a comprehensive evolution in diagnostic radiology, where progressive regulatory frameworks, robust deployment platforms, standardized evaluation practices, and active clinician engagement converge to drive the safe, effective, and patient-centered integration of AI into clinical workflows
Alcohol Consumption Among First-Year College Students: A Survey of Two Universities
No full textPurpose: Among college students, high alcohol consumption on a given day can lead to impaired decision making. Understanding the prevalence of alcohol consumption behavior at colleges is necessary for developing effective prevention and intervention strategies. In the United States (US), drinking habits of women at colleges has shown to be on par with their counterpart men especially in recent years according to national survey data. However, drinking culture may vary by campus. This study conducted a survey to investigate alcohol consumption behavior of first-year students from two college campuses as part of a hybrid type 1 effectiveness-implementation trial. Methods: First-year undergraduates in Spring 2024 were recruited from the University of North Texas (UNT) and the University of Kentucky (UK). An email invitation to complete a Qualtrics survey was sent to a random sample of first-year students between the ages of 18-20. 22% of UNT students responded and 15% of UK students responded. Students who are pregnant or trying to become pregnant, or in treatment for alcohol or substance use were excluded. In this project, we investigated self-reported alcohol behaviors (During the past month, how many days did you have at least one drink of alcohol?; Think of the occasion you drank the most in the past month. How much did you drink?). Descriptive statistics of the variables were calculated across each campus and gender. Results: 299 students completed the survey at UNT and 182 students completed the survey at UK. Among female students at each campus, 41% at UNT reported drinking in the past month compared to 63% at UK. Among male students at each campus, 27% at UNT reported drinking in the past month compared to 49% at UK. UNT females reported 1.38 days drinking and males reported 0.78 days drinking. UK females reported 2.39 days drinking and males reported 2.59 days drinking. Overall, UNT students reported an average of 1.09 days drinking while UK students reported 2.48 days drinking in the past month. After treating those who did not report drinking in the past month as consuming zero drinks, we observed UNT students reported 1.39 drinks (1.57 drinks by females; 1.19 drinks by males) on the occasion they drank the most compared to the 2.80 drinks (2.41 drinks by females; 3.22 drinks by males) reported by UK students. Conclusion: Alcohol behaviors can differ by college and gender, suggesting heterogeneity in the US first-year college student populations. A better understanding of campus-specific alcohol use norms is important for developing comparatively more effective and tailored interventions for alcohol consumption and related health behaviors for college student populations. In addition, more research with multiple systems-level campus stakeholders is necessary to implement interventions that may be acceptable, feasible, and highly engaging for target populations. (Support: R01AA028246
Primary Cardiac Rhabdomyosarcoma With Lung Mass: A Rare Battle of Long-term Survival
No full textBackground: Primary cardiac tumors are uncommon, occurring in about 0.02% of the population. Malignant tumors account for roughly 15% of these cases, with sarcomas being predominant. We present a rare case of left atrial rhabdomyosarcoma (RMS) with metastasis to left upper lobe of the lung Case Presentation: A 68-year-old male presented with worsening dyspnea, fever and cough for past five days. He was diagnosed with biopsy proven RMS with left atrial mass four years earlier, treated with doxorubicin, ifosfamide, and vincristine chemotherapy in a tertiary hospital. Given subsequent recurrence in the left atrial appendage one year prior to this presentation, he underwent successful surgical resection, placement of a Medtronic bioprosthetic mitral valve, and radiation therapy. On examination, he was febrile, tachypneic, had irregular heart rate of 110 bpm, normal blood pressure and oxygen saturation of 91% on 4L of nasal oxygen. A contrast-enhanced computed tomography (CT) scan of the chest revealed large filling defects in the left atrium extending into the left superior pulmonary veins, as well as a 4.6 x 2.9 cm mass in the left upper lobe para-mediastinal region and bilateral alveolar infiltrates with pleural effusions. He subsequently underwent successful thoracentesis and a CT-guided needle biopsy of the mass, both confirming metastatic RMS with embryonal features. Conclusions: RMS tumors arise from immature cells and myogenic satellite cells intended for the formation of striated skeletal muscle. Symptoms include progressive dyspnea, unexplained heart failure, precordial pain, and pericardial effusions. Tumors originating in the left atrium often grow into the atrial lumen, causing symptoms by obstructing blood flow or leading to mitral regurgitation often mimicking outflow obstruction. Intramural extension leads to arrhythmias, conduction abnormalities, and even sudden death. RMS can metastasize to the lungs, mediastinum, thoracic lymph nodes, and vertebral column. Diagnostics include echocardiography, cardiac magnetic resonance imaging (MRI), cardiac CT, positron emission tomography (PET) scans, coronary angiography, and cardiac biopsy. Most patients experience recurrence, with a median survival of approximately 6 to 12 months. Neoadjuvant or adjuvant chemotherapy, radiation, and cardiac auto-transplantation are employed to improve survival rates. Our patient survived for four years; however, despite aggressive treatment, he developed lung metastasis and ultimately succumbed to heart failure, post-obstructive pneumonia, and respiratory failure. Primary cardiac rhabdomyosarcoma is an extremely rare tumor with a generally poor prognosis, primarily due to late diagnosis. Echocardiography serves as an initial diagnostic tool. Long survival and lung metastasis is relatively is a rare occurrence
Perioperative Outcomes of Freehand vs CT Model Drill Guides for Posterior Spinal Fusion in Pediatric Scoliosis Patients
No full textPurpose: While numerous studies have compared perioperative outcomes between freehand and CT model drill guides for pedicle screw placement in posterior spinal fusion, few have focused on radiation exposure specific to pediatric scoliosis patients. This study purpose is to evaluate differences in radiation exposure and perioperative outcomes between these two techniques in this population. Methods: Pediatric patients who underwent spinal fusion at Cook Children's Medical Center (Fort Worth, Texas) between January 2022 and January 2023 were included. A retrospective chart review was performed to collect preoperative and intraoperative data on radiation dose and perioperative outcomes. Fisher’s exact test was used to analyze associations between screw placement technique and gender or complications. Continuous variables, described using medians and interquartile ranges (IQR) due to non-normally distributed data, were analyzed with the non-parametric Mann-Whitney U test. Results: A total of 82 pediatric patients were assessed: 38 freehand placement, and 44 CT model-guided placement. No significant association for gender (p=.24) or complications (p=.78) were found between the two groups. Additionally, no significant differences were found between the two groups in terms of age (p=.25), number of screws placed (p=.12), levels fused (p=0.16), estimated blood loss (p=.81), or length of surgery (p=.15). Postoperative radiation doses were higher in the freehand group compared to the CT model group (p = 0.05). Unexpectedly, preoperative radiation exposure was higher in the freehand group than the CT model group, however statistical significance was not reached (p=.06). Conclusion: CT-guided pedicle screw placement reduces radiation exposure in pediatric spinal fusion without compromising other perioperative outcomes. These findings are significant in mitigating the harmful effects of ionizing radiation for both patients and staff. Future studies should further explore the benefits and limitations of CT-guided techniques in pediatric scoliosis patient
In vivo imaging of astrocyte-retinal ganglion cell metabolic exchange by PET/MR
No full textPoster Highlight: College of Biomedical and Translational Science, RAD 2025 Award Winning Posters & Oral PresentationsPurpose: Glaucoma is a condition of the eye characterized by increased intraocular pressure and progressive neurodegeneration that affects millions of people globally. Astrocytes, the most abundant glial cells in the CNS, play a critical role in brain homeostasis and metabolic support. These cells are interconnected by gap junctions primarily made of connexin 43. Previous studies suggest that astrocyte-mediated redistribution of metabolites occurs during the progression of glaucoma. Metabolic resources are transferred through astrocyte gap junctions from the healthy eye to the contralateral eye affected by ocular hypertension (OHT) via the optic nerve. This transfer may serve as an endogenous mechanism to reduce bioenergetic stress. Glucose transporter-1 (GLUT1) enables astrocytic glucose uptake, but its role in metabolic redistribution under OHT remains unclear. The objective of this study is to utilize real-time imaging of metabolic transfer in the rodent eye using PET/MR to examine whether knockout (KO) of GLUT1 in astrocytes inhibits glucose uptake and consequently affects glucose redistribution toward hypertensive eye. Method: We modeled glaucoma-associated neurodegeneration in mice with GLUT1 removed from GFAP-positive astrocytes on a C57BL/6 background (GFAP-ERT2-cre x flox’d GLUT1; male and female, n = 12) by inducing unilateral ocular hypertension (OHT) using the magnetic bead injection method to elevate intraocular pressure. We analyzed 4 groups: GLUT1-knockout (KO) + OHT, Control+OHT, GLUT1-KO and Control. Fluorine-18 fluorodeoxyglucose (¹⁸F-FDG) was unilaterally intravitreally injected into the uninjured eye with 70 to 110 mCi/2~5 μL to investigate the glucose redistribution pattern to the contralateral (injured, OHT) eye. The simultaneous and sequential PET/MR imaging was acquired by using the MR compatible PET scanner (MR Solutions sequential PET/MR scanner) in the Preclinical Imaging Core. The 7T MR system with a mouse small volume quadrature (MSVQ) coil (298 MHz) was used for the imaging study. The standardized uptake value (SUV, g/mL) which represents ¹⁸F-FDG retention adjusted for the injected dose and mouse body weight, were calculated using VivoQuant™. The percentage of the standardized uptake value (SUV) in the contralateral eye was calculated relative to the whole-body SUV value. Results: FDG transport to the contralateral eye was significantly higher in the Control+OHT group (3.76%) compared to the GLUT1-KO + OHT group (0.18%), with a statistically significant difference (P < 0.001). Minimal to no transport or redistribution of ¹⁸F-FDG was observed in the GLUT1-KO, and Control groups. Conclusion: This study highlights ¹⁸F-FDG PET imaging as a potential diagnostic tool for monitoring metabolic redistribution in glaucoma. Visualizing the role of GLUT1 in astrocyte-mediated glucose transport could lay the groundwork for developing diagnostic and prognostic strategies, ultimately guiding targeted therapies to preserve retinal ganglion cells
Migration and invasion enhancer1 (MIEN1): A potential gene to target colorectal cancer metastasis
No full textPoster Highlight: College of Biomedical and Translational Science, RAD 2025 Award Winning Posters & Oral PresentationsMigration and invasion enhancer1 (MIEN1): A potential gene to target colorectal cancer metastasis Pragati Singh, Amit Kumar Tripathi, Nafees Ahamad, Jamboor k Vishwanatha Department of Microbiology, Immunology and Genetics, University of North Texas Health Science Center, Fort Worth, Texas Colorectal cancer metastasis represents a substantial life threating malignancy. As per previous research, approximately 50% of colorectal cancer patients develop liver metastasis which is also an important cause of lethality. Migration and invasion enhancer1 (MIEN1) is an important gene, initially investigated as an key regulator of tumor cell migration and invasion. It has been detected in different types of cancers such as breast cancer, ovarian cancer, prostate cancer, gastric cancer, nonsmall cell lung cancer. However, the role of MIEN-1 in the colorectal cancer metastasis is still unclear and requires further elucidation for the development of potential therapeutics. In the present study we have focused our study on the colorectal cancer cells (CRCs), derived from both human and murine origins (HT29, T84, CT26, Sw620) for in-vitro experiments. Expression analysis was conducted using immunoprecipitation and western blotting to assess MIEN1 levels across different cell lines. Additionally, to determine its role in epithelial mesenchymal transition, migration and proliferation of CRCs, we performed migration and invasion assays, wound healing assay, using human and murine colorectal cancer cells. CRCs of metastatic origin showed enhanced migration and speedy wound healing in comparison to CRCs of primary tumor origin. To further investigate the role of MIEN1 in colorectal cancer metastasis in vivo, we have also developed GFP+luciferase positive CRCs (MIEN1 knockout and wild type). Additionally, series of experiments were conducted to examine MIEN1’s role in colorectal cancer metastasis. Present investigation offers promising novel approach to understand the role of MIEN1 in metastatic colorectal cancer
Phonemic Cueing as a Marker for Processing Speed in Vascular Dementia and Temporal Lobe Dysfunction in Alzheimer’s Disease
No full textPurpose: Phonemic cueing during the Boston Naming Test (BNT) is a valuable tool for examining cognitive processes, particularly in neurodegenerative disorders. This study explores the hypothesis that phonemic cue responses on the BNT can mark subcortical processing speed deficits in vascular dementia (VaD) versus temporal lobe dysfunction in Alzheimer’s disease (AD). Objective: To determine whether differences in the ability to utilize phonemic cues on the BNT reflect distinct patterns of cognitive dysfunction in VaD and AD. Methods: Patients with VaD and AD have completed the BNT, with performance assessed based on phonemic cue use and response accuracy. Group differences would be analyzed to evaluate whether phonemic cueing benefits VaD patients more than AD patients, reflecting different cognitive mechanisms. Results: It is hypothesized that VaD patients will benefit more from phonemic cues than AD patients, as VaD involves processing delays but preserves response initiation, whereas AD impairs retrieval due to temporal lobe dysfunction. These differences are expected to highlight distinct neurocognitive profiles and aid in differential diagnosis. Conclusions: The anticipated findings would support phonemic cueing on the BNT as a useful, non-invasive marker for distinguishing processing speed deficits in VaD from retrieval impairments in AD. This could enhance diagnostic accuracy, refine neuropsychological assessments, and guide targeted dementia interventions. References: Baldo, J. V., Schwartz, S., Wilkins, D., & Dronkers, N. F. (2006). Role of frontal versus temporal cortex in verbal fluency as revealed by voxel-based lesion symptom mapping. Journal of the International Neuropsychological Society, 12(6), 896–900. https://doi.org/10.1017/S1355617706061078 Becker, J. T., Boller, F., Saxton, J., & McGonigle-Gibson, K. L. (1987). Normal rates of forgetting of verbal and non-verbal material in Alzheimer's disease. Cortex, 23(1), 59–72. https://doi.org/10.1016/S0010-9452(87)80019-7 Crawford, J. R., Henry, J. D., Ward, A. L., & Blake, J. (2006). The prospective and retrospective memory questionnaire (PRMQ): Normative data and latent structure in a large non-clinical sample. Memory, 14(3), 229–245. https://doi.org/10.1080/09658210500277575 Gleason, C. E., Fiske, A., & Storey, J. E. (2003). The role of verbal fluency in the differential diagnosis of Alzheimer's disease and major depressive disorder. Journal of Clinical and Experimental Neuropsychology, 25(4), 431–438. https://doi.org/10.1076/jcen.25.4.431.13878 Henry, J. D., Crawford, J. R., & Phillips, L. H. (2004). Verbal fluency performance in dementia of the Alzheimer’s type: A meta-analysis. Neuropsychologia, 42(9), 1212–1222. https://doi.org/10.1016/j.neuropsychologia.2004.02.001 Hirono, N., Mori, E., Ikejiri, Y., Imamura, T., Shimomura, T., Ikeda, M., & Yamashita, H. (1998). Neurobehavioral correlates of memory preservation in Alzheimer’s disease. Journal of Geriatric Psychiatry and Neurology, 11(2), 59–63. https://doi.org/10.1002/gps.2229 Jefferson, A. L., & Poppas, A. (2011). Processing speed mediates the relationship between vascular and executive function in aging. Journal of the International Neuropsychological Society, 17(3), 439–445. https://doi.org/10.1017/S1355617711000227 Price, S. E., Jefferson, A. L., & Walker, R. Q. (2011). Recognition memory and verbal fluency differentiate probable Alzheimer’s disease from subcortical ischemic vascular dementia. Journal of the International Neuropsychological Society, 17(5), 687–696. https://doi.org/10.1017/S1355617711000574 Weintraub, S., Wicklund, A. H., & Salmon, D. P. (2012). The neuropsychological profile of Alzheimer disease. Current Directions in Psychological Science, 21(2), 106–110. https://doi.org/10.1177/096372141243680
ENDOSCOPIC ULTRASOUND IN THE MANAGEMENT OF PEDIATRIC PATIENTS WITH SUSPECTED CHOLEDOCHOLITHIASIS
No full textBackground: Gallbladder disease in the pediatric population has been steadily increasing in the U.S. The management of choledocholithiasis is Endoscopic Retrograde Cholangiopancreatography (ERCP) which might necessitate a laparoscopic cholecystectomy for stones in the gallbladder. However, ERCP is associated with the risk of post ERCP pancreatitis. Endoscopic Ultrasound (EUS) is a minimally invasive procedure, yielding high-quality images of the digestive and biliary tract. With regards to gallstones, EUS can detect stones lodged in the biliary tract, all the way to the duodenal papilla. However, limited literature exists on the use of EUS in children with suspected choledocholithiasis with no studies exploring the number of ERCP that were averted. Aim: The primary aim of this project is to evaluate the safety and clinical outcomes of EUS in pediatric patients with suspected choledocholithiasis. The secondary aim of this project is to evaluate how many ERCP procedures were averted by performing an EUS. Methods: The data for this project was obtained from an IRB-approved registry among pediatric patients in whom EUS was indicated and pediatric gastroenterology consultation was sought. Results: A total of 67 EUS procedures were performed on pediatric patients presenting with suspected choledocholithiasis over 1.5 years by a stand-alone pediatric gastroenterologist trained in EUS. There were a total of 9 ERCPs (13.4%) that were averted by doing a EUS. The most common symptoms reported were abdominal pain, vomiting. Six patients had a past medical history of sickle cell disease. Five patients presented with persisting abdominal pain post cholecystectomy which warranted further exploration with EUS and ERCP for evaluation of stone in the common bile duct. 32(47.8%) had a BMI- Obese (≥95 percentile),11 of 63 patients experienced symptoms along with elevated lipase levels suggestive of gallstone pancreatitis. A direct bilirubin of 0.8 mg/dl or more and a common bile duct diameter (CBD) of 6.6 mm or more has a greater probability of stone in the CBD. Prior to EUS, imaging for suspected choledocholithiasis included USG abdomen and magnetic resonance cholangiopancreatography performed in 50 and 19 patients respectively. Of the 19 patients who underwent MRCP, 5 (26.3 %) had findings that were not concordant with EUS. No complications were reported following EUS. Firth’s logistic regression was employed to determine any significant differences between the ERCP averted group and the group that underwent ERCP following EUS. No significant differences were observed between the two groups. Discussion & Conclusion: This preliminary data demonstrates that EUS can be safely performed in pediatric patients with symptoms suggestive of choledocholithiasis to visualize the biliary tract and assess the need for ERCP
Histidine ammonia lyase expression characteristics in primary liver cancer: hepatocellular carcinoma and cholangiocarcinoma
Get PDFBACKGROUND: Histidine (His) ammonia Lyase (HAL) is a key rate-limiting enzyme that catalyzes the first reaction in the metabolism of histidine. Deficiencies in HAL lead to histidinemia, characterized by elevated levels of His in the blood and other body fluids. The level of HAL in these fluids is known to impact the sensitivity of cancer cells to certain chemotherapeutics by regulating His. However, the molecular role and impacts of HAL in the progression of hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) are unknown at present. Thus, we investigated the expression of HAL in HCC and CCA tumors. METHOD: The Cancer Genome Atlas (TCGA) database, quantitative real-time PCR (qRT-PCR), and immunoblot analysis were utilized to examine the expression of HAL in HCC and CCA patients. RESULTS: TCGA analysis revealed a significant downregulation of HAL mRNA expression in HCC and CCA tumor tissues compared with normal tissues (p < 0.0001). Our qRT-PCR and immunoblot analysis demonstrated a significant decrease in both HAL mRNA (HCC, n = 9, p < 0.05; CCA, n = 7, p < 0.05) and protein levels (HCC, 91.7%, 22/24; CCA, 92.9%, 13/14) in both HCC and CCA tumor tissues compared with adjacent non-tumor liver/ bile duct tissues across the majority of patient samples analyzed. The protein expression pattern aligns with the mRNA findings, indicating that HAL downregulation occurs at both transcriptional and protein levels. CONCLUSION: Our data evinced the relevance and significance of HAL in the tumorigenesis of HCC and CCA. These findings suggest that HAL and its metabolic derivatives can be developed as a potential prognostic and diagnostic biomarker as well as therapeutics for HCC and CCA.This research was partly supported by the National Institutes of Health grant CA283524 (PC), AI179337 (IWP) and the UNTHSC Seed Grant to PC and IWP. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health
“Doctor, I can’t move!” - A Case of Functional Neurological Disorder in an Incarcerated Patient
No full textBackground: Functional Neurological Disorder (FND), also known as Conversion Disorder, is a condition where a person can experience physical and sensory problems, such as paralysis, numbness, blindness, or seizures that are incongruent with other known neurological pathology. Onset may be rapid and abrupt with a waxing and waning course. Work up for FND, in addition to the standard work up of labs, includes an MRI of the brain and spine. Previously thought to be a disorder of exclusion, more recent research has found “rule in” signs that can help with the diagnosis of functional disorders, including reversibility of symptoms (Peeling & Muzio, 2023). This disorder is typically associated with stressful life events and comorbid mental health disorders, such as anxiety, depression, and substance use disorder. Although the workup can be unremarkable and incongruent with other neurological pathology, the symptoms are still real, thus treatment should integrate multiple disciplines to address symptoms and underlying cause. Part of treatment includes psychotherapy, physical therapy, and other modalities to help with symptomatic relief. Case Presentation: In this case study, a 33-year old incarcerated male presents with sudden functional limb weakness in the setting of unremarkable labs, physical exam, and imaging. He was unable to consciously move his limbs and did not react to painful or tactile stimuli in his bilateral lower extremities. Patient exhibited a desire to improve his symptoms and return to jail rather than being hospitalized. He was then diagnosed with FND and treatment was attempted with psychotherapy and physical therapy. After several days of hospitalization, the patient's symptoms improved and was able to be discharged. Conclusion: This case brings attention to FND and its presentation as it can often be mistaken as feigned symptoms, even within the healthcare field. This is important as vulnerable populations with limited access to resources, such as the homeless or incarcerated, may experience FND as a result of significant stressors but have their symptoms dismissed as a result of their demographics