bluuebunny/crossref_metadata_2025 huggingface dataset:
Prediction of medical expenditures of diagnosed diabetics and the assessment of its related factors using a random forest model, MEPS 2000–2015
Authors: Wang Jing , Shi Leiyu
Published: December 2019

Objective

To predict the medical expenditures of individual diabetics and assess the related factors of it.

Design and setting

Cross-sectional study.

Setting and participants

Data were collected from the US household component of the medical expenditure panel survey, 2000–2015.

Main outcome measure

Random forest (RF) model was performed with the programs of randomForest in R software. Spearman correlation coefficients (rs), mean absolute error (MAE) and mean-related error (MRE) was computed to assess the prediction of all the models.

Results

Total medical expenditure was increased from $105 Billion in 2000 to $318 Billion in 2015. rs, MAE and MRE between the predicted and actual values of medical expenditures in RF model were 0.644, $0.363 and 0.043%. Top one factor in prediction was being treated by the insulin, followed by type of insurance, employment status, age and economical level. The latter four variables had no impact in predicting of medical expenditure by being treated by the insulin. Further, after the sub-analysis of gender and age-groups, the evaluating indicators of prediction were almost identical to each other. Top five variables of total medical expenditure among male were same as those among all the diabetics. Expenses for doctor visits, hospital stay and drugs were also predicted with RF model well. Treatment with insulin was the top one factor of total medical expenditure among female, 18-, 25- and 65-age-groups. Additionally, it indicated that RF model was little superior to traditional regression model.

Conclusions

RF model could be used in prediction of medical expenditure of diabetics and assessment of its related factors well.
Parallel Reaction Monitoring-Based Quantification of Cannabinoids in Whole Blood
Authors: Joye Timothée , Widmer Christèle , Favrat Bernard , Augsburger Marc , Thomas Aurélien
Published: December 2019

Cannabis is the most consumed drug of abuse, making it the primary target for identification and quantification in human whole blood regarding forensic and clinical toxicology analyses. Among biological matrices, blood is the reference for toxicological interpretation. A highly sensitive and selective liquid chromatography (LC) hyphenated with high-resolution mass spectrometry (HRMS) was developed for the quantification of Δ9-tetrahydrocannabinol (THC), 11-hydroxytetrahydrocannabinol (THC-OH), 11-nor-9-carboxy-tetrahydrocannabinol (THC-COOH) and cannabidiol (CBD). Those cannabinoids were extracted from 1 mL of whole blood by a simple liquid–liquid extraction (LLE) in acidic conditions. HRMS was performed on an Orbitrap-based instrument using its trapping capabilities and increased selectivity for parallel reaction monitoring (PRM) quantification in positive polarity with a negative polarity switching for THC-OH and THC-COOH. Although selected reaction monitoring (SRM) and PRM-targeted methods have similar performance in terms of linearity, dynamic range, precision and repeatability, Orbitrap-based PRM provides a higher specificity due to the use of high-resolution mode separating background ions from the targeted molecules. The method was fully validated according to guidelines set forth by the “Société Française des Sciences et des Techniques Pharmaceutiques” (SFSTP). Trueness was measured below 107% for all tested concentrations. Repeatability and intermediate precision were found to be lower than 12% while the assay was found to be linear in the concentration range of 0.4–20 ng/mL for THC, THC-OH and CBD and of 2–100 ng/mL for THC-COOH. Recovery (RE) and matrix effect (ME) ranged from 70.6 to 102.5% and from −40 to 6.6%, respectively. The validated method provides an efficient procedure for the simultaneous and rapid quantification of cannabinoids in PRM mode providing an alternative over classical SRM.
XXL Survey groups and clusters in the Hyper Suprime-Cam Survey. Scaling relations between X-ray properties and weak lensing mass
Authors: Sereno Mauro , Umetsu Keiichi , Ettori Stefano , Eckert Dominique , Gastaldello Fabio , Giles Paul , Lieu Maggie , Maughan Ben , Okabe Nobuhiro , Birkinshaw Mark , Chiu I-Non , Fujita Yutaka , Miyazaki Satoshi , Rapetti David , Koulouridis Elias , Pierre Marguerite
Published: December 2019

Scaling relations trace the formation and evolution of galaxy clusters. We exploited multi-wavelength surveys – the XXL survey at XMM-Newton in the X-ray band, and the Hyper Suprime-Cam Subaru Strategic Program for optical weak lensing – to study an X-ray selected, complete sample of clusters and groups. The scalings of gas mass, temperature, and soft-band X-ray luminosity with the weak lensing mass show imprints of radiative cooling and active galactic nucleus feedback in groups. From the multi-variate analysis, we found some evidence for steeper than self-similar slopes for gas mass ($\beta _{m_\text{g}|m}=1.73 \pm 0.80$) and luminosity (βl|m = 1.91 ± 0.94) and a nearly self-similar slope for the temperature (βt|m = 0.78 ± 0.43). Intrinsic scatters of X-ray properties appear to be positively correlated at a fixed mass (median correlation factor $\rho _{X_1X_2|m}\sim 0.34$) due to dynamical state and merger history of the haloes. Positive correlations with the weak lensing mass (median correlation factor $\rho _{m_\text{wl}X|m}\sim 0.35$) can be connected to triaxiality and orientation. Comparison of weak lensing and hydrostatic masses suggests a small role played by non-thermal pressure support ($9\pm 17{{\ \rm per\ cent}}$).
A consistency test for determining whether ultracompact dwarf galaxies could be the remnant nuclei of threshed galaxies
Authors: Graham Alister W
Published: December 2019

It has been suggested that ultracompact dwarf (UCD) galaxies are the ‘threshed’ remains of larger galaxies. Simulations have revealed that extensive tidal-stripping may pare a galaxy back to its tightly bound, compact nuclear star cluster. It has therefore been proposed that the two-component nature of UCD galaxies may reflect the original nuclear star cluster surrounded by the paltry remnants of its host galaxy. A simple quantitative test of this theory is devised and applied here. If the mass of the central black hole (BH) in UCD galaxies, relative to the mass of the UCD galaxies’ inner stellar component, i.e. the suspected nuclear star cluster, matches with the (black hole mass)–(nuclear star cluster mass) relation observed in other galaxies, then it would provide quantitative support for the stripped galaxy scenario. Such consistency is found for four of the five UCD galaxies reported to have a massive BH. This (black hole mass)–(nuclear star cluster mass) relation is then used to predict the central BH mass in two additional UCD galaxies, and to reveal that NGC 205 and possibly NGC 404 (which only has an upper limit to its black hole mass) also follow this scaling relation.
Aerothermodynamic modelling of meteor entry flows
Authors: Bariselli Federico , Frezzotti Aldo , Hubin Annick , Magin Thierry E
Published: December 2019

Due to their small size and tremendous speeds, meteoroids often burn up at high altitudes above 80 km, where the atmosphere is rarefied. Ground radio stations allow us to detect the concentration of electrons in the meteoroid trail, which are produced by hyperthermal collisions of ablated species with the freestream. The interpretation of these data currently relies on phenomenological methods, derived under the assumption of free molecular flow, that poorly accounts for the detailed chemistry, diffusion in the vapour phase, and rarefied gas effects. In this work, we employ the direct simulation Monte Carlo (DSMC) method to analyse the detailed flowfield structure in the surroundings of a 1 mm meteoroid at different conditions, spanning a broad spectrum of Knudsen and Mach numbers, and we extract resulting ionization efficiencies. For this purpose, we couple the DSMC method with a kinetic boundary condition which models evaporation and condensation processes in a silicate material. Transport properties of the ablated vapour are computed following the Chapman–Enskog theory starting from Lennard–Jones potentials. Semi-empirical inelastic cross-sections for heavy- and electron-impact ionization of metals are computed analytically to obtain steric factors. The ionization of sodium is dominant in the production of free electrons, and hyperthermal air–vapour collisions play the most important role in this process. The ionization of air, classically disregarded, contributes to the electron production as significantly as ionization of magnesium and iron. Finally, we propose that DSMC could be employed as a numerical experiment providing ionization coefficients to be used in synthetic models.
The nature of the photometric variability of HgMn stars: a test of simulated light curves of φ Phe against the TESS data
Authors: Prvák Milan , Krtička Jiří , Korhonen Heidi
Published: December 2019

The inhomogeneous surface distribution of heavy elements is known to cause periodic light variability of magnetic chemically peculiar stars. It is unclear to what extent the same paradigm applies to mercury–manganese (HgMn) stars. We aim to model the photometric variability of the HgMn star φ Phe using abundance maps obtained from high-resolution spectroscopy and to study how this variability evolves with time. We compute a grid of atlas12 model atmospheres and the corresponding synspec synthetic spectra. Interpolating within this grid and integrating the specific intensity over the visible stellar surface at different rotational phases, we obtain theoretical light curves of the star. We predict the variability of φ Phe in the ultraviolet and in the visible spectral regions with amplitude of the order of millimagnitudes, mainly caused by absorption in lines of yttrium, chromium, and titanium. We also show how this variability is affected by changes of the distribution of the heavy elements over time. The main characteristics of the predicted light variability of φ Phe correspond roughly to the variability of the star observed with the Transiting Exoplanet Survey Satellite (TESS).
Photoionization modelling of quiescence-phase spectra of novae and a symbiotic star
Authors: Mondal Anindita , Das Ramkrishna , Anupama G C , Mondal Soumen
Published: December 2019

Using observed and published spectra in the optical region, we have studied a handful of novae and symbiotic stars that show novae-like variability in the quiescence phase. We present results for the novae T Coronae Borealis, GK Persei, RS Ophiuchi, V3890 Sagittarii and V745 Scorpii, and for a symbiotic star BX Monocerotis. Observations were carried out at the 2-m Himalayan Chandra Telescope (HCT). Generally, the spectra show prominent low-ionization emission features of hydrogen, helium, iron and oxygen and TiO absorption features resulting from the cool secondary component; T Coronae Borealis and GK Persei show higher ionization lines. We used the photoionization code cloudy to model these spectra. From the best-fitting models, we have estimated the physical parameters (e.g. temperature, luminosity and hydrogen density), the elemental abundances and other parameters related to the system. By matching the spectra of various giants with the absorption features and using the best fit, we have determined the types of secondaries and also their contribution to the spectra.
Suzaku and Fermi view of the supernova remnant 3C 396
Authors: Sezer A , Ergin T , Cesur N , Tanaka S J , Kisaka S , Ohira Y , Yamazaki R
Published: December 2019

3C 396 is a composite supernova remnant (SNR), consisting of a central pulsar wind nebula (PWN) and a bright shell in the west, which is known to be interacting with molecular clouds (MCs). We present a study of X-ray emission from the shell and the PWN of the SNR 3C 396 using archival Suzaku data. The spectrum of the SNR shell is clearly thermal, without a signature of a non-thermal component. The abundances of Al and Ca from the shell are slightly enhanced, which indicates the presence of metal-enriched supernova ejecta. The PWN spectra are well described by a power-law model with a photon index of ∼1.97 and a thermal component with an electron temperature of ∼0.93 keV. The analysis of about 11 yr of Fermi data revealed an 18σ detection of gamma-ray emission from the location overlapping with the position of 3C 396 / 4FGL J1903.8+0531. The spectrum of 3C 396 / 4FGL J1903.8+0531 is best fitted with a log-parabola function with parameters of α = 2.66 and β = 0.16 in the energy range of 0.2–300 GeV. The luminosity of 3C 396 / 4FGL J1903.8+0531 was found to be >1035 erg s−1 at 6.2 kpc, which rules out the inverse Compton emission model. Possible scenarios of gamma-ray emission are hadronic emission and bremsstrahlung processes, due to the fact that the SNR is expanding into dense MCs in the western and northern regions of the SNR.
The pancaking of coronal mass ejections: an in situ attestation
Authors: Raghav Anil N , Shaikh Zubair I
Published: December 2019

The interplanetary counterparts of coronal mass ejections (ICMEs) are the leading driver of severe space weather. Their morphological evolution in interplanetary space and the prediction of their arrival time at Earth are the ultimate focus of space weather studies, because of their scientific and technological effects. Several investigations in the last couple of decades have assumed that ICMEs have a circular cross-section. Moreover, various models have also been developed to understand the morphology of ICMEs based on their deformed cross-section. In fact, simulation studies have suggested that the initial circular cross-section flattens significantly during their propagation in the solar wind and this is referred to as ‘pancaking’. However, an observational verification of this phenmenon is still pending and it will eventually be the primary concern of several morphological models. Here, we report the first unambiguous observational evidence of extreme flattening of the cross-section of ICMEs, similar to pancaking, based on in situ measurements of 30 ICME events. In fact, we conclude that the cross-section of ICME flux ropes transformed into a two-dimensional planar magnetic structure. Such a deformed morphological feature not only alters the prediction of their arrival time but also has significant implications in solar-terrestrial physics, the energy budget of the heliosphere, charged particle energization, turbulence dissipation and enhanced geo-effectiveness, etc.
Antiretroviral Treatment Simplification With 2-Drug Regimens: Impact of Transmitted Drug Resistance Mutations
Authors: Kessler Harald H , Stelzl Evelyn , Blažič Anja , Mehta Sanjay R , Benezeder Anna S , Genger-Hackl Christina , Santner Brigitte I , Chaillon Antoine , Hoenigl Martin
Published: December 2019

The frequency of clinically relevant transmitted drug resistance mutations (DRMs) against drugs used for 2-drug regimens was 15.6%, but only 2% were not eligible for 1 or more 2-drug regimens. More than 50% of patients harboring any clinically relevant DRMs were found to be part of genetic transmission clusters.
Lateral Femoral Cutaneous Nerve Radiofrequency Ablation for Long-term Control of Refractory Meralgia Paresthetica
Authors: Abd-Elsayed Alaa , Gyorfi Michael J , Ha Sung P
Published: December 2019

Background

Meralgia paresthetica is a term used to describe a clinical pain syndrome related to the compression or irritation of the lateral femoral cutaneous nerve (LFCN). The LFCN is a pure sensory nerve that is susceptible to compression injury. The most common compression locations are: as it courses from the lumbosacral plexus, through the abdominal cavity, under the inguinal ligament, and into the subcutaneous tissue of the thigh.

Methods

This case series is a retrospective single-center review of six patients with medically intractable meralgia paresthetica who were treated with radiofrequency ablation. To be considered for radiofrequency ablation, the patient must have been unsuccessful with medical management alone for more than two months and have a clinical diagnosis of meralgia paresthetica. Temporary relief of pain of 50% or greater was considered a positive result. Average pain scores were measured pre- and postprocedure, along with one-, two-, three-, and six-month intervals postoperation.

Results

All patients demonstrated immediate relief in self-reported pain scores, averaging a 75.5% reduction in pain. At the one-, two-, three-, and six-month follow-ups, patients averaged a reduction of 60.0%, 58.0%, 51.4%, and 40.5%, respectively. Both the postop and one-month follow-up pain scores were lower, statistically significantly so (P < 0.05), whereas the two-, three-, and six-month follow-ups were not statistically different from pretreatment scores.

Conclusions

Although our study was small, radiofrequency ablation showed a clear reduction in average pain scores in a subset of patients who had failed standard medical therapy with a reduction in pain at one-month follow-up with relief of symptoms sometimes lasting longer than 12 months.
Incidence of venous thromboembolism following initiation of non-steroidal anti-inflammatory drugs in U.S. women
Authors: Kinsey Tracy L , Stürmer Til , Funk Michele Jonsson , Poole Charles , Simpson Ross J , Glynn Robert J
Published: December 2019

Objective

To evaluate the risk of venous thromboembolism (VTE, i.e. deep vein thrombosis or pulmonary embolism, or both) following new use of NSAIDs in a long-term cohort of U.S. women.

Methods

We investigated initiation of coxibs and traditional NSAIDs (excluding aspirin) and incident VTE in 39 876 women enrolled in the Women’s Health Study from 1993–95 and followed with yearly questionnaires until 2012. We defined initiation as the first reported use of NSAIDs for ≥4 days per month. Incident VTE was confirmed by an end point committee. We estimated hazard ratios (HRs) and risk differences (RDs, expressed as percentages) comparing NSAID initiation with non-initiation and acetaminophen initiation (active comparator) via standardization using a propensity score that incorporated age, BMI, calendar time, and relevant medical, behavioural, and socioeconomic variables updated over time.

Results

The HR (95% CI) for risk of VTE in the as treated analyses comparing initiation with non-initiation, was 1.5 (1.2, 1.8) for any NSAID, 1.3 (1.1, 1.7) for traditional NSAIDs, and 2.0 (1.3, 3.1) for coxibs, with 2-year RDs 0.11, 0.08 and 0.32, respectively. When comparing the risk of VTE after initiation of any NSAID with that after acetaminophen initiation, the HRs were 0.9 (0.6, 1.5), 0.9 (0.5, 1.5) and 1.4 (0.6, 3.4), with 2-year RDs 0.03, –0.01, and 0.13, respectively.

Conclusion

New use of NSAIDs was associated with increased VTE risk compared with non-use, but the association was null or diminished when compared with acetaminophen initiation. Elevated VTE risks associated with NSAID use in observational studies may in part reflect different baseline risks among individuals who need analgesics and may overstate the risk patients incur compared with pharmacologic alternatives.
DEMONSTRATION OF THE POTENTIAL AND DIFFICULTIES OF COMBINED TL AND OSL MEASUREMENTS OF TLD-600 AND TLD-700 FOR THE DETERMINATION OF THE DOSE COMPONENTS IN COMPLEX NEUTRON-GAMMA RADIATION FIELDS
Authors: Oster L , Eliyahu I , Horowitz Y S , Reshes G , Shapiro A , Garty G
Published: December 2019

The results reported herein demonstrate the potential application of combined optically stimulated luminescence/thermoluminescent (OSL/TL) measurements in neutron-gamma discrimination dosimetry. The advantages of OSL/TL are two-fold: (i) The OSL and TL readout can be carried out on the same sample and (ii) the greater efficiency of OSL to high ionization density radiation due to F 2 and F3 excitation. The gamma/electron calibration coefficients for LiF:Mg, Ti (TLD-600 and TLD-700) were measured using a 90Sr/90Y source calibrated at the SARAF-SSDL nuclear facility. The estimation of the neutron calibration coefficients was carried out by irradiation with broad-spectrum beam of fast neutrons with median energy 5 MeV at the Radiological Research Accelerator Facility (RARAF) of Columbia University. Naturally cooled samples of TLD-600 and TLD-700 were dosed to levels of 29.8 Gy neutrons and 6.1 Gy gammas in air and KERMA calculations employed to transfer the levels of dose to6,7LiF. A figure of merit for fast-neutron/gamma ray discrimination was determined at 10.6 for TLD-700 in the current measurements. The use of combined TLD-600/TLD-700 allowed, as well, the determination of a considerable and somewhat unexpected thermal neutron component of 116 Gy in TLD-600.
Assessing the Causal Effects of Human Serum Metabolites on 5 Major Psychiatric Disorders
Authors: Yang Jian , Yan Bin , Zhao Binbin , Fan Yajuan , He Xiaoyan , Yang Lihong , Ma Qingyan , Zheng Jie , Wang Wei , Bai Ling , Zhu Feng , Ma Xiancang
Published: December 2019

Psychiatric disorders are the leading cause of disability worldwide while the pathogenesis remains unclear. Genome-wide association studies (GWASs) have made great achievements in detecting disease-related genetic variants. However, functional information on the underlying biological processes is often lacking. Current reports propose the use of metabolic traits as functional intermediate phenotypes (the so-called genetically determined metabotypes or GDMs) to reveal the biological mechanisms of genetics in human diseases. Here we conducted a two-sample Mendelian randomization analysis that uses GDMs to assess the causal effects of 486 human serum metabolites on 5 major psychiatric disorders, which respectively were schizophrenia (SCZ), major depression (MDD), bipolar disorder (BIP), autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD). Using genetic variants as proxies, our study has identified 137 metabolites linked to the risk of psychiatric disorders, including 2-methoxyacetaminophen sulfate, which affects SCZ (P = 1.7 × 10–5) and 1-docosahexaenoylglycerophosphocholine, which affects ADHD (P = 5.6 × 10–5). Fourteen significant metabolic pathways involved in the 5 psychiatric disorders assessed were also detected, such as glycine, serine, and threonine metabolism for SCZ (P = .0238), Aminoacyl-tRNA biosynthesis for both MDD (P = .0144) and ADHD (P = .0029). Our study provided novel insights into integrating metabolomics with genomics in order to understand the mechanisms underlying the pathogenesis of human diseases.
The Natural History of Insomnia: the incidence of acute insomnia and subsequent progression to chronic insomnia or recovery in good sleeper subjects
Authors: Perlis Michael L , Vargas Ivan , Ellis Jason G , Grandner Michael A , Morales Knashawn H , Gencarelli Amy , Khader Waliuddin , Kloss Jaqueline D , Gooneratne Nalaka S , Thase Michael E
Published: December 2019

Study Objectives

The primary aim of the present study was to estimate the incidence per annum of acute insomnia and to what extent those that develop acute insomnia recover good sleep or develop chronic insomnia. Unlike prior studies, a dense-sampling approach was used here (i.e. daily diaries) and this allowed for a more precise detection of acute insomnia and the follow-on states (the transitions to either recovery or chronic insomnia).

Methods

Good sleeper subjects (n = 1,248; 67% female) that were at least 35 years old participated in this prospective study on the natural history of insomnia. Subjects were recruited nationwide and completed online assessments for 1 year. The online measures consisted primarily of daily sleep diaries, as well as weekly/bi-weekly and monthly measures of sleep, stress, and psychological and physical health.

Results

The 1-year incidence rate of acute insomnia was 27.0% (n = 337). The incidence rate of chronic insomnia was 1.8% (n = 23). Of those that developed acute insomnia, 72.4% (n = 244) went on to recover good sleep. 19.3% (n = 65) of the acute insomnia sample continued to experience persistent poor sleep, but did not meet criteria for chronic insomnia.

Conclusions

The incidence rate of acute insomnia (3 or more nights a week for between 2 and 12 weeks) is remarkably high. This said, most incident cases resolve within a few days to weeks. Incident chronic insomnia only occurs in about 2 in 100 individuals.
Modified Natural-Cycle Cryopreserved Embryo Transfer: Is a Washout Period Needed After a Failed Fresh Cycle?
Authors: Horowitz Eran , Mizrachi Yossi , Farhi Jacob , Shalev Amir , Raziel Arieh , Weissman Ariel
Published: December 2019

(Abstracted from Reprod Biomed Online 2019;39(3):439–445)

Embryo cryopreservation and frozen embryo transfer (FET) in assisted reproductive technology currently accounts for up to one third of all children born in the United States using assisted reproductive technology. Embryo cryopreservation's increase in utilization is driven by advances in procedures associated with the technology as well as increased understanding of downstream effects associated with ovarian stimulation.
Ulipristal Acetate vs Gonadotropin-Releasing Hormone Agonists Prior to Laparoscopic Myomectomy (MYOMEX Trial): Short-term Results of a Double-blind Randomized Controlled Trial
Authors: de Milliano Inge , Huirne Judith A. F. , Thurkow Andreas L. , Radder Celine , Bongers Marlies Y. , van Vliet Huib , van de Lande Jonas , van de Ven Peter M. , Hehenkamp Wouter J. K.
Published: December 2019

(Abstracted from Acta Obstet Gynecol Scand 2019; doi: 10.1111/aogs.13713)

Two agents used for pretreatment of fibroids before myomectomy are gonadotropin-releasing hormone agonists (GnRHa)—considered a criterion standard—and ulipristal acetate (UPA), a selective progesterone receptor modulator (SPRM) recently approved for preoperative treatment. No randomized trials have compared pretreatment of uterine fibroids with GnRHa or UPA prior to laparoscopic myomectomy.
The Graduate Medical Education (GME) Gold Rush: GME Slots and Funding as a Financial Asset
Authors: Aizenberg David Jacob , Logio Lia Suzanne
Published: December 2019

The unprecedented displacement of more than 550 trainees that occurred because of the closure of Hahnemann University Hospital has demonstrated that the medical education community, Centers for Medicare and Medicaid Services, and the Accreditation Council for Graduate Medical Education were unprepared for a graduate medical education (GME) crisis of this scale. The authors offer a first-hand perspective of the chaotic environment that ensued following the announcement of the hospital’s closure and of the challenges faced by trainees and program leadership looking to ensure trainees found a landing program that was a good fit for them. The authors review the complexity of GME funding and how the owners of Hahnemann University Hospital leveraged this in an attempt to offset debt. The lessons learned from the authors’ experience can help inform the medical education community’s response to this type of crisis in the future.
US Trends of Opioid-use Disorders and Associated Factors Among Hospitalized Patients With Spinal Conditions and Treatment From 2005 to 2014
Authors: Lee Se Won , Shen Jay , Kim Sun Jung , Chun Sung-Youn , Kim Pearl , Riaz Jahan , Yoo Ji Won , Hwang Jinwook
Published: December 2019

Study Design.

Serial cross-sectional study utilizing the National Inpatient Sample (NIS) 2005 to 2014.

Objective.

The aim of this study was to examine the trends of opioid-use disorders among hospitalized patients with spinal conditions and treatment and to identify its contributing factors.

Summary of Background Data.

The opioid is widely used in chronic spinal conditions, and misuse of prescriptions is the main culprit of the opioid crisis. Cannabis, the most commonly utilized illicit drug, has recently been substituted for opioid despite increasing cannabis-use emergency room visits. There is limited information on opioid-use disorders, the association with cannabis, and other contributing factors.

Methods.

We analyzed the 2005 to 2014 NIS data that identified opioid-use disorders among hospitalized patients with cervical and lumbar spinal conditions and treatment using the International Classification of Disease, Ninth Revision-Clinical Modification codes for opioid abuse, dependence, poisoning, and cervical and lumbar spinal diseases and procedures. The compound annual growth rate (CAGR) was used to quantify trends of opioid-use disorders among hospitalized patients. Multilevel and multivariable regression analyses were performed to determine their contributing factors.

Results.

The number of hospitalizations with spinal conditions and treatment increased from 2005 to 2011, then decreased between 2011 and 2014 with an overall decrease in length of stay, resulting in the CAGR of −1.60% (P < .001). Almost 3% (2.93%, n = 557,423) of hospitalized patients with spinal conditions and treatment were diagnosed as opioid-use disorders and its CAGR was 6.47% (P < .0001). Opioid-use disorders were associated with cannabis-use disorders (odds ratio 1.714), substance use, mental health condition, younger age, white race, male sex, higher household income, and public insurance or uninsured.

Conclusion.

This study suggests that opioid-use disorders are increasing among hospitalized patients with spinal conditions and treatment and associated with several demographic, and socioeconomic factors, including cannabis-use disorders.

Level of Evidence: 3
Developing a better biopsychosocial understanding of pain in inflammatory bowel disease: a cross-sectional study
Authors: Sweeney Louise , Moss-Morris Rona , Czuber-Dochan Wladyslawa , Murrells Trevor , Norton Christine
Published: December 2019

Objective

Pain is frequently reported by patients with inflammatory bowel disease (IBD). Pain in IBD is not fully explained by disease activity or other clinical findings, and a recent systematic review suggested that psychosocial factors have an important role in IBD-pain. The aim of this study was to investigate psychosocial factors associated with pain in IBD.

Methods

297 adults (>16 years) with IBD were recruited from outpatient clinics (n = 114) and online (n = 183). Participants completed validated questionnaires assessing pain and potential emotional, cognitive and behavioural correlates. Socio-demographic and clinical factors including disease activity were also recorded.

Results

243 (81.8%) of participants reported pain. Of these 243, mean age was 36 years; 153 (63%) had Crohn’s disease, 90 (37%) had ulcerative colitis, and 165 (67.9%) were female. 62.6% reported mild, 31.6% moderate and 5.8% severe pain. 40.3% of participants with pain met established criteria for chronic pain and 18.5% reported opioid use. Female gender, smoking, surgery and steroid use were associated with greater pain severity. Psychosocial factors associated with pain-related interference included depression, catastrophising, fear avoidance, lower self-efficacy and worse mental well-being. Regression models explained 45.6% of the variance in pain severity and 49.7% of pain interference. Psychosocial factors explained 9.5% and 24% of this variance respectively when controlling for demographic and clinical variables.

Conclusions

Pain in IBD is significantly associated with cognitive and behavioural factors as well as low mood. This study contributes to a biopsychosocial understanding of pain in IBD and identifies important targets for future interventions.
Fragility index: how fragile is the data that support the American College of Gastroenterology guidelines for the management of Crohn’s disease?
Authors: Majeed Muhammad , Agrawal Rohit , Attar Bashar M. , Kamal Shaheera , Patel Palak , Omar Yazan Abu , Demetria Melchor , Agrawal Priyanka , Gandhi Seema
Published: December 2019

Randomized controlled trials (RCTs) are the cornerstone of evidence-based medicine. However, recent literature has drawn attention to the limitations of using P-value to report statistical significance of outcomes in the clinical trials. We performed this analysis to analyze the strength of the data that supported the American College of Gastroenterology (ACG) guidelines for ‘Management of Crohn’s disease in adults’ using fragility index (FI). We screened all the RCTs referenced in the 2018 ACG guidelines ‘Management of Crohn’s disease in adults’. We calculated the FI and the fragility quotient (FQ) and its correlation with P-value. Data were also collected on the patients lost to follow up, year of publication, sample size, number needed to treat (NNT), science citation index (SCI), presence of blinding and the number of centers in these studies. Of the 91 RCTs cited in this guideline, 32 RCTs met the inclusion criteria. The median values for FI for 32 trials were 3 [interquartile range (IQR) 2–6], FQ 0.026 (IQR 0.012–0.413), P-value 0.010 (IQR 0.001–0.03), lost to follow up 17 (IQR 10–39.5) and sample size 133 (IQR 74.5–281.5). There was statistically significant correlation between FI and P-value (r
s –0.86, P <0.001) and sample size (r
s 0.56, P = 0.002). There was no correlation found with number lost to follow up, NNT, SCI, year of publication, blinding and number of centers. The majority of the RCTs conducted in the field of Crohn’s disease rely on small number of superior events for statistical significance, thus rendering the validity of their conclusion questionable. At least 18 out of 60 ACG recommendations are based on RCTs in which, number of patients lost to follow up exceeds FI, thus making reported outcomes of the trial weak. We suggest that FI and FQ should be included in clinical trials to better understand if the data are meaningful, beyond a P-value.
Point-of-care ultrasound in the neonatal ICU
Authors: Miller Laura E. , Stoller Jason Z. , Fraga María V.
Published: December 2019

Purpose of review

Point-of-care ultrasound (POCUS) is an emerging clinical tool in the neonatal intensive care unit (NICU). Recent literature describing the use of POCUS for various applications in the NICU has garnered increased interest among neonatologists.

Recent findings

Diagnostic applications for POCUS in the NICU include the evaluation and serial monitoring of common pulmonary diseases, hemodynamic instability, patent ductus arteriosus (PDA), persistent pulmonary hypertension of the newborn (PPHN), necrotizing enterocolitis (NEC), and intraventricular hemorrhage (IVH), among others. Procedural applications include vascular access, endotracheal intubation, lumbar puncture, and fluid drainage.

Experience with POCUS in the NICU is growing. Current evidence supports the use of POCUS for a number of diagnostic and procedural applications. As use of this tool increases, there is an urgent need to develop formal training requirements specific to neonatology, as well as evidence-based guidelines to standardize use across centers.
The future of cellular immunotherapy for childhood leukemia
Authors: Bonifant Challice L. , Tasian Sarah K.
Published: December 2019

Purpose of review

Exciting translational discoveries in recent years have brought realized promise of immunotherapy for children with high-risk leukemias. This review summarizes the current immunotherapeutic landscape with a focus on key clinical trials for patients with acute lymphoblastic leukemia or acute myeloid leukemia.

Recent findings

Chemotherapy resistance remains a major barrier to cure in children with high-risk leukemias. Immunotherapy approaches have potential to overcome this resistance given alternative mechanisms of action. Based upon preclinical activity and/or success in adult patients, recent clinical trials have demonstrated safety and efficacy of various mAb, antibody–drug conjugate, bispecific T-cell-engaging antibody, natural killer cell, and chimeric antigen receptor-redirected T-cell immunotherapies for children with acute lymphoblastic leukemia or acute myeloid leukemia. Food and Drug Administration approval of several of these immunotherapies has increased the pediatric leukemia therapeutic portfolio and improved clinical outcomes for previously incurable patients.

Several antibody-based or cellular immunotherapy modalities have demonstrated appreciable efficacy in children with relapsed or chemotherapy-refractory leukemia via early-phase clinical trials. Some studies have also identified critical biomarkers of treatment response and resistance that merit further investigation. Continued preclinical and clinical evaluation of novel immunotherapies is imperative to improve cure rates for children with high-risk leukemias.
Preimplantation Genetic Testing for Aneuploidy: A Review
Authors: Kemper James M. , Vollenhoven Beverley J. , Talmor Alon J.
Published: December 2019

Importance

Preimplantation genetic testing for aneuploidy (PGT-A) has undergone many technical developments over recent years, including changes in biopsy timings, methodology, and genetic analysis techniques. The evidence surrounding the efficaciousness of PGT-A is sporadic and inconsistent; as such, significant doubt and concern remain regarding its widespread implementation.

Objective

This review seeks to describe the historical development of PGT-A and to analyze and summarize the current published literature.

Conclusions

At times during its infancy, PGT-A failed to display conclusive improvements in results; with newer technologies, PGT-A appears to yield superior outcomes, including reductions in miscarriages and multiple gestations. Clinicians and patients should assess the use of PGT-A on a case-by-case basis, with laboratories encouraged to utilize blastocyst biopsy and next-generation sequencing when conducting PGT-A. Further studies providing cumulative live birth rates and time to live birth are required if PGT-A is to be proven as producing superior outcomes.

Relevance

PGT-A has the potential ability to impact in vitro fertilization success rates, and as it is increasingly adopted worldwide, it is crucial that clinicians are aware of the evidence for its continued use.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After reading this review, physicians should be better able to summarize the history of PGT-A, including the development over time of biopsy and analytical techniques; explain the continued uncertainty regarding the efficacy of PGT-A and the associated safety concerns; and assess the impact mosaicism may have on the interpretation of PGT-A results and subsequent treatment recommendations.
Associations Between Migraine and Adverse Pregnancy Outcomes: Systematic Review and Meta-analysis
Authors: Aukes Annet M. , Yurtsever Feyza N. , Boutin Amélie , Visser Marieke C. , de Groot Christianne J. M.
Published: December 2019

Importance

Migraine is a highly prevalent disorder associated with cardiovascular diseases. Cardiovascular diseases are also associated with preeclampsia (PE). The adverse pregnancy outcomes PE, preterm birth (PTB), low birth weight (LBW), small for gestational age (SGA) and placental abruption share aspects in their pathophysiology, which are also found in patients with migraine, such as inflammatory stress and hypercoagulability.

Objective

To determine the association of adverse pregnancy outcomes including PE, PTB, LBW, SGA, and placental abruption with a history of migraine through a systematic review and meta-analysis.

Evidence Acquisition

MEDLINE (PubMed), the Cochrane Library, and EMBASE, were searched from inception to November 11, 2018. Cohort studies and case-control studies evaluating migraine history and pregnancy complications were eligible.

Results

Of 1388 screened references, 14 studies were included in the systematic review. There were higher risks of PE (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.51–2.85; I
2 = 76%) and LBW (OR, 1.18; 95% CI, 1.03–1.34; I
2 = 9%) in women with migraine compared with women without migraine. We observed no significant association between history of migraine and PTB (OR, 1.23; 95% CI, 0.97–1.55; I
2 = 61%) or SGA (OR, 1.06; 95% CI, 0.98–1.15; I
2 = 0%).

Conclusions

A history of migraine is significantly associated with an increased risk of adverse pregnancy outcomes including PE and LBW. We hypothesize that shared pathophysiology due to underlying preclinical cardiovascular risk in women with migraine might play a role during pregnancy.

Relevance

Pregnant women with a history of migraine should be considered at higher risk of adverse pregnancy outcomes and should be informed, monitored, and treated preventively accordingly.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to: Describe the association between migraine and placenta-induced pregnancy complications; Explain the possibility of the developing preeclampsia in women with a history of migraine; and Assess the risk of preterm birth or a neonate with low birth weight or small for gestational age in women with migraine.
Transvaginal Trigger Point Injections Improve Pain Scores in Women With Pelvic Floor Hypertonicity and Pelvic Pain Conditions
Authors: Bartley Jamie , Han Esther , Gupta Priyanka , Gaines Natalie , Killinger Kim A. , Boura Judith A. , Farrah Morgan , Gilleran Jason , Sirls Larry T. , Peters Kenneth M.
Published: December 2019

(Abstracted from Female Pelvic Med Reconstr Surg 2019;25:392–396)

About 1 in 7 women in the United States has chronic pelvic pain. This condition has a negative impact on quality of life as a result of significant physical, emotional, and psychological effects.
Critical ischemia and myonecrotic sepsis following scapulothoracic dissociation in the setting of apparent hand perfusion
Authors: Labrum Joseph T. , Desai Mihir J. , Naslund Thomas C. , Obremskey William T.
Published: December 2019

Scapulothoracic dissociation is a rare and devastating injury to the shoulder girdle. It is often caused by traction or severe blunt trauma injury to the upper extremity and is associated with both neurologic and vascular injuries. Scapulothoracic dissociation is a highly morbid and rare injury pattern that is often seen in conjunction with other traumatic injuries. The authors describe a case of scapulothoracic dissociation with associated complete brachial plexus injury and subclavian artery injury that was complicated by hypoperfusion, myonecrosis, and subsequent polymicrobial infection of the affected limb in the setting of a warm hand with brisk capillary refill. While capillary refill and hand warmth in the setting of a pulseless extremity have been used in previous cases of scapulothoracic dissociation as an indication for limb perfusion and nonoperative management, these markers cannot reliably be used to evaluate collateral circulation as exemplified in this case report. This case highlights multiple important aspects of the evaluation and management of scapulothoracic dissociation that orthopaedic surgeons and vascular surgeons should be familiar with and utilize when dealing with these challenging injuries.

Level of Evidence: V
Chimpanzees use tree species with a resonant timbre for accumulative stone throwing
Authors: Kalan Ammie K. , Carmignani Eleonora , Kronland-Martinet Richard , Ystad Sølvi , Chatron Jacques , Aramaki Mitsuko
Published: December 2019

Animals use tools for communication relatively rarely compared to tool use for extractive foraging. We investigated the tool-use behaviour accumulative stone throwing (AST) in wild chimpanzees, who regularly throw rocks at trees, producing impact sounds and resulting in the aggregations of rocks. The function of AST remains unknown but appears to be communication-related. We conducted field experiments to test whether impact sounds produced by throwing rocks at trees varied according to the tree's properties. Specifically, we compared impact sounds of AST and non-AST tree species. We measured three acoustic descriptors related to intrinsic timbre quality, and found that AST tree species produced impact sounds that were less damped, with spectral energy concentrated at lower frequencies compared to non-AST tree species. Buttress roots in particular produced timbres with low-frequency energy (low spectral centroid) and slower signal onset (longer attack time). In summary, chimpanzees use tree species capable of producing more resonant sounds for AST compared to other tree species available.
Paul Gordon Jarvis. 23 May 1935—5 February 2013
Authors: Grace John
Published: December 2019

Paul Gordon Jarvis was a widely known and well-respected plant ecologist and physiologist, who pioneered the scientific analysis of the exchange of water and carbon dioxide between forests and the atmosphere, and laid the foundations for decades of study on the interplay between forests and the climate system. He was one of the first to measure directly the photosynthesis and transpiration of forests, and leading from this, his analysis of the relationships between the physiology of plants and the weather has informed and inspired a generation of young scientists. In particular, he was one of the first to address the linkage between knowledge gained at the microscopic scale of stomata and the landscape scale of forests, and the implications of that linkage for the climate system.
Indirect actuation reduces flight power requirements inManduca sextavia elastic energy exchange
Authors: Gau Jeff , Gravish Nick , Sponberg Simon
Published: December 2019

In many insects, wing movements are generated indirectly via exoskeletal deformations. Measurements of inertial and aerodynamic power suggest that elastic recovery of energy between wingstrokes might reduce power requirements of flight. We tested three questions. (1) Can the thorax itself provide significant energy return? (2) Does a simple damped elastic model describe the bulk mechanical behaviour? (3) Are different regions of the thorax specialized for elastic energy exchange? We measured deformation mechanics of the hawkmothManduca sextathorax by recording the force required to sinusoidally deform the thorax over a wide frequency range. Elastic energy storage in the thorax is sufficient to minimize power requirements. However, we find that a structural (frequency-independent) damping model, not a viscoelastic model, best describes the thorax’s mechanical properties. We next performed complementary experiments on a structurally damped homogeneous hemisphere. In contrast to the hemispherical shell, we find that mechanical coupling between different regions of the thorax improves energy exchange performance and that local mechanical properties depend on global strain patterns. Specifically, the scutum region provides energy recovery with low dissipation, while the majority of energy loss occurred in the wing hinge region, highlighting the specificity of thorax regions for flight energetics.
DNA damage in human skin and the capacities of natural compounds to modulate the bystander signalling
Authors: Markiewicz Ewa , Idowu Olusola Clement
Published: December 2019

Human skin is a stratified organ frequently exposed to sun-generated ultraviolet radiation (UVR), which is considered one of the major factors responsible for DNA damage. Such damage can be direct, through interactions of DNA with UV photons, or indirect, mainly through enhanced production of reactive oxygen species that introduce oxidative changes to the DNA. Oxidative stress and DNA damage also associate with profound changes at the cellular and molecular level involving several cell cycle and signal transduction factors responsible for DNA repair or irreversible changes linked to ageing. Crucially, some of these factors constitute part of the signalling known for the induction of biological changes in non-irradiated, neighbouring cells and defined as the bystander effect. Network interactions with a number of natural compounds, based on their known activity towards these biomarkers in the skin, reveal the capacity to inhibit both the bystander signalling and cell cycle/DNA damage molecules while increasing expression of the anti-oxidant enzymes. Based on this information, we discuss the likely polypharmacology applications of the natural compounds and next-generation screening technologies in improving the anti-oxidant and DNA repair capacities of the skin.