bluuebunny/crossref_metadata_2025 huggingface dataset:
Mesh Migration Results in Asymptomatic Sigmoid Perforation as Long-Term Complication After Difficult TAPP: a Case Report
Authors: Liedtke Kim R. , Liedtke Claudia , Kleinwort Annabel , Döring Paula , Glitsch Anne S. , Schreiber André
Published: April 2020

Hernia surgery is the most common surgical procedure worldwide. Complications are very rare and usually manifest in recurrence or chronic pain. We report a rare case of mesh migration 14 years after initially complicated transabdominal preperitoneal plastic for left-sided inguinal hernia. The mesh migration resulted in a covered sigmoid perforation, which was completely asymptomatic and only noticed as a chance finding in a staging CT scan prior to irradiation therapy. However, after the onset of immunosuppressive therapy, an exacerbation of chronic, localized inflammation was expected. Therefore, open surgical anterior rectum resection was performed, and after a short hospital stay, the patient could be discharged home free of complaints. This case report aims to raise awareness of possible long-term complications of hernia repair when using non-absorbable meshes.
Reduction of the serotonin 5-HT1B and 5-HT2A receptor-mediated contraction of human pulmonary artery by the combined 5-HT1B receptor antagonist and serotonin transporter inhibitor LY393558
Authors: Baranowska-Kuczko Marta , Kozłowska Hanna , Schlicker Eberhard , Göthert Manfred , MacLean Margaret R. , Kozłowski Mirosław , Kloza Monika , Sadowska Olga , Malinowska Barbara
Published: April 2020

Background

LY393558 is a combined antagonist of serotonin (5-HT) 5-HT1B receptors and inhibitor of serotonin transporter (SERT). LY393558 reduces 5-HT-induced vasoconstriction and remodelling of rat and/or mouse pulmonary arteries. The aim of our study was to examine the effect of LY393558 on the 5-HT-stimulated vasoconstriction of human pulmonary arteries (hPAs) and to determine the underlying mechanism(s).

Methods

Vascular effects of 5-HT receptor agonists, antagonists and a SERT inhibitor were examined in organ bath studies on intralobar hPAs obtained from patients during resection of lung carcinoma.

Results

Serotonin and agonists of the 5-HT1B receptor (5-carboxamidotryptamine, 5-CT) and 5-HT2A receptor (α-methyl-5-HT) contracted endothelium-intact hPAs in a concentration-dependent fashion. The 5-HT1B antagonists SB224289 and GR55562 reduced responses induced by 5-HT and 5-CT and the 5-HT2A antagonist ketanserin inhibited the effects of 5-HT and α-methyl-5-HT. Administration of the SERT inhibitor citalopram (at a concentration that failed to modify the 5-HT-induced vasoconstriction) in combination with SB224289 or GR55562 was more effective in inhibiting the response to 5-HT than the 5-HT1B antagonists alone. LY393558 showed the greatest antagonistic effect against the vasoconstriction elicited by 5-HT, 5-CT and α-methyl-5-HT.

Conclusions

LY393558 reduces the 5-HT-induced contraction antagonizing 5-HT1B and 5-HT2A receptors probably due to synergic interaction between SERT inhibition and 5-HT1B receptor antagonism. Thus, it might represent a valuable future option in the pulmonary arterial hypertension therapy.
In vitro evaluation of degradable electrospun polylactic acid/bioactive calcium phosphate ormoglass scaffolds
Authors: Majchrowicz Anna , Roguska A. , Krawczyńska A. , Lewandowska M. , Martí-Muñoz J. , Engel E. , Castano O.
Published: April 2020

Nowadays, the main limitation for clinical application of scaffolds is considered to be an insufficient vascularization of the implanted platforms and healing tissues. In our studies, we proposed a novel PLA-based hybrid platform with aligned and random fibrous internal structure and incorporated calcium phosphate (CaP) ormoglass nanoparticles (0, 10, 20 and 30 wt%) as an off-the-shelf method for obtaining scaffolds with pro-angiogenic properties. Complex morphological and physicochemical evaluation of PLA–CaP ormoglass composites was performed before and after in vitro degradation test in SBF solution to assess their biological potential. The degradation process of PLA–CaP ormoglass composites was accompanied by numerous CaP-based precipitations with extended topography and cauliflower-like shape which may enhance bonding of the material with the bone tissue and accelerate the regenerative process. Random fiber orientation was preferable for CaP compounds deposition upon in vitro degradation. CaP compounds precipitated firstly for randomly oriented composite nonwovens with 20 and 30 wt% addition of ormoglass. Moreover, the preliminary bioactivity test has shown that BSA adsorbed to PLA–CaP ormoglass composites (both aligned and randomly oriented) with 20 and 30 wt% of ormoglass nanoparticles which was not observed for pure PLA scaffolds.
Longitudinal Risk of Developing Cardiovascular Diseases in Patients with Erectile Dysfunction—Which Patients Deserve More Attention?
Authors: Pozzi Edoardo , Capogrosso Paolo , Boeri Luca , Belladelli Federico , Baudo Andrea , Schifano Nicolò , Abbate Costantino , Dehò Federico , Montorsi Francesco , Salonia Andrea
Published: April 2020

Background

Erectile dysfunction (ED) is widely considered as an early manifestation of cardiovascular diseases (CVDs), sharing similar risk factors.

Aim

Assess rates and predictors of developing CVD and/or hypertension (HTN) over a long-term follow-up period using user-friendly and clinically reliable tools in men presenting with ED but without CVD/HTN or known vascular risk factors at baseline.

Methods

Data from 108 patients presenting between 2005 and 2011 with ED were analyzed. All patients were free from CVD and/or HTN (CVD/HTN) at baseline. Patients completed the International Index of Erectile Function (IIEF) at baseline and were followed up every 6 months with clinical assessment or phone interview. Kaplan-Meier analyses estimated the probability of developing CVD/HTN over time. Cox-regression models tested the association between patient baseline characteristics (for example, age, Charlson Comorbidity Index, baseline IIEF-EF, ED severity, alcohol intake, smoking), response to phosphodiesterase type-5 inhibitors (PDE5is), and the risk of developing CVD/HTN.

Results

Of all, 43 (40%) patients showed IIEF-EF scores suggestive of severe ED; 37 (39%) and 59 (61%) were nonresponders and responders to PDE5i, respectively. Median (interquartile range) age was 51 (41, 61) years. Median (interquartile range) follow-up was 95 (86-106) months. Overall, the estimated risk of developing CVD/HTN was 15% (95% confidence interval [CI]: 9-27) at 10-year assessment. Men with baseline severe ED had a higher risk of developing CVD/HTN (34%; 95% CI: 17-59, P = .03) at 10 years than patients with mild to moderate ED (5% [95% CI: 2-14]). At the Cox regression analysis, severe ED (Hazard ratio [HR], 4.62; 95% CI: 1.43, 8.89; P = .01) and baseline IIEF-EF score (HR, 0.92; 95% CI: 0.86, 0.99; P = .02) were associated to the risk of CVD/HTN overtime. Conversely, age and nonresponders to PDE5is (HR, 0.92; 95% CI: 0.32, 2.68; P = .9) were not associated to a risk of CVD/HTN over time.

Clinical Implications

The use of an easy and user-friendly tool, as the IIEF-EF domain score, would allow to reliably assess which men with ED at first presentation may deserve a different, more specific and detailed cardiologic investigation to prevent inauspicious CV events.

Strengths & Limitations

A single-center-based, observational longitudinal study, raising the possibility of selection biases are the main limits.

Conclusions

Patients with severe ED and lower baseline IIEF-EF but no vascular risk factors at first presentation have more than 30% risk of developing CVD/HTN in 10-year time. Those patients may benefit from medical preventive strategies to lowering the risk of CV events and HTN.
Demarginalizing Standpoint Epistemology
Authors: Toole Briana
Published: April 2020

Standpoint epistemology, the view that social identity is relevant to knowledge-acquisition, has been consigned to the margins of mainstream philosophy. In part, this is because the principles of standpoint epistemology are taken to be in opposition to those which guide traditional epistemology. One goal of this paper is to tease out the characterization of traditional epistemology that is at odds with standpoint epistemology. The characterization of traditional epistemology that I put forth is one which endorses the thesis of intellectualism, the view that knowledge does not depend on non-epistemic features. I then suggest that two further components – the atomistic view of knowers and aperspectivalism – can be usefully interpreted as supporting features of intellectualism. A further goal of this paper is to show that we ought to resist this characterization of traditional epistemology. I use pragmatic encroachment as a dialectical tool to motivate the denial of intellectualism, and consequently, the denial of both supporting components. I then attempt to show how it is possible to have a view, similar to pragmatic encroachment, that takes social identity, rather than stakes, to be the feature that makes a difference to what a person is in a position to know.
Anthropological perspectives on the trajectory from institutionalisation to community care in Irish psychiatry
Authors: Kelly B. D.
Published: April 2020

The trajectory of the anthropology of Irish psychiatry, like the trajectory of Irish psychiatry itself, is indelibly shaped by the history of Irelandʼs mental hospitals. This paper focuses on three works concerning the anthropology of psychiatry in Ireland: Nancy Scheper-Hughesʼs book, Saints Scholars and Schizophrenics: Mental Illness in Rural Ireland, an anthropological study (1977/2001); Eileen Kaneʼs paper, ‘Stereotypes and Irish identity: mental illness as a cultural frame’, from Studies: An Irish Quarterly Review (1986) and Michael D’Arcyʼs conference paper, ‘The hospital and the Holy Spirit: psychotic subjectivity and institutional returns in Dublin, Ireland’ (2015), based on his PhD dissertation. All three publications explore the relationship between institutional and community psychiatric care in Ireland, concluding with the work of D’Arcy which, like much good anthropology, is rooted in the lived experience of mental illness and combines deep awareness of the past with tolerance of multiple, ostensibly contradictory narratives in the present.
Change Is in the Air: The Smell of Marijuana, after Legalization
Authors: Garriott William
Published: April 2020

Marijuana continues to be legalized throughout the world. In the United States, a unique approach to legalization is taking hold that focuses on the creation of commercial marijuana markets. This article examines the everyday realities of this approach to legalization through a focus on one of marijuana’s most legally significant attributes: its smell. In the context of prohibition, the smell of marijuana was a key tool of criminal law enforcement. In the context of legalization, its significance has expanded to include nuisance laws governing the presence of unwanted odors and commercial laws that facilitate economic activity in the marijuana market. By focusing on the sense of smell in the context of marijuana legalization, this article shows the implications of the market-based approach for drug policy reform. More broadly, this focus highlights the importance of the senses to sociolegal change and the ongoing construction of legality in the context of capitalism.
The structure of emotional support networks in families affected by Lynch syndrome
Authors: Marcum Christopher Steven , Lea Dawn , Eliezer Dina , Hadley Donald W. , Koehly Laura M.
Published: April 2020

Genetic risk is particularly salient for families and testing for genetic conditions is necessarily a family-level process. Thus, risk for genetic disease represents a collective stressor shared by family members. According to communal coping theory, families may adapt to such risk vis-a-vis interpersonal exchange of support resources. We propose that communal coping is operationalized through the pattern of supportive relationships observed between family members. In this study, we take a social network perspective to map communal coping mechanisms to their underlying social interactions and include those who declined testing or were not at risk for Lynch Syndrome. Specifically, we examine the exchange of emotional support resources in families at risk of Lynch Syndrome, a dominantly inherited cancer susceptibility syndrome. Our results show that emotional support resources depend on the testing-status of individual family members and are not limited to the bounds of the family. Network members from within and outside the family system are an important coping resource in this patient population. This work illustrates how social network approaches can be used to test structural hypotheses related to communal coping within a broader system and identifies structural features that characterize coping processes in families affected by Lynch Syndrome.
Plasma concentrations of vitamin B12 and folate and global cognitive function in an older population: cross-sectional findings from The Irish Longitudinal Study on Ageing (TILDA)
Authors: O’Connor Deirdre M. A. , Laird Eamon J. , Carey Daniel , O’Halloran Aisling M. , Clarke Robert , Kenny R. A. , Molloy Anne M.
Published: April 2020

The uncertainty surrounding high intakes of folic acid and associations with cognitive decline in older adults with low vitamin B12 status has been an obstacle to mandatory folic acid fortification for many years. We estimated the prevalence of combinations of low/normal/high vitamin B12 and folate status and compared associations with global cognitive function using two approaches, of individuals in a population-based study of those aged ≥50 years in the Republic of Ireland. Cross-sectional data from 3781 men and women from Wave 1 of The Irish Longitudinal Study on Ageing were analysed. Global cognitive function was assessed by the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Prevalence estimates for combinations of vitamin B12 (plasma vitamin B12 < or ≥258 pmol/l) and folate (plasma folate ≤ or >45·3 nmol/l) concentrations were generated. Negative binomial regression models were used to investigate the associations of vitamin B12 and folate status with global cognitive function. Of the participants, 1·5 % (n 51) had low vitamin B12 (<258 pmol/l) and high folate (>45·3 nmol/l) status. Global cognitive performance was not significantly reduced in these individuals when compared with those with normal status for both B-vitamins (n 2433). Those with normal vitamin B12/high folate status (7·6 %) had better cognitive performance (MMSE: incidence rate ratio (IRR) 0·82, 95 % CI 0·68, 0·99; P = 0·043, MoCA: IRR 0·89, 95 % CI 0·80, 0·99; P = 0·025). We demonstrated that high folate status was not associated with lower cognitive scores in older adults with low vitamin B12 status. These findings provide important safety information that could guide fortification policy recommendations in Europe.
When descriptive ecology meets physiology: a study in a South Atlantic rhodolith bed
Authors: Carvalho V. F. , Silva J. , Kerr R. , Anderson A. B. , Bastos E. O. , Cabral D. , Gouvêa L. P. , Peres L. , Martins C. D. L. , Silveira-Andrade V. M. , Sissini M. N. , Horta P. H.
Published: April 2020

This study presents two years of characterization of a warm temperate rhodolith bed in order to analyse how certain environmental changes influence the community ecology. The biomass of rhodoliths and associated species were analysed during this period andin situexperiments were conducted to evaluate the primary production, calcification and respiration of the dominant species of rhodoliths and epiphytes. The highest total biomass of rhodoliths occurred during austral winter.Lithothamnion crispatumwas the most abundant rhodolith species in austral summer. Epiphytic macroalgae occurred only in January 2015, withPadina gymnosporabeing the most abundant. Considering associated fauna, the biomass of Mollusca increased from February 2015 to February 2016. Population densities of key reef fish species inside and around the rhodolith beds showed significant variations in time. The densities of grouper (carnivores/piscivores) increased in time, especially from 2015 to 2016. On the other hand, grunts (macroinvertebrate feeders) had a modest decrease over time (from 2014 to 2016). Other parameters such as primary production and calcification ofL. crispatumwere higher under enhanced irradiance, yet decreased in the presence ofP. gymnospora. Community structure and physiological responses can be explained by the interaction of abiotic and biotic factors, which are driven by environmental changes over time. Biomass changes can indicate that herbivores play a role in limiting the growth of epiphytes, and this is beneficial to the rhodoliths because it decreases competition for environmental resources with fleshy algae.
Modelling fine-scale distribution and relative abundance of harbour porpoises in the Southern Bight of the North Sea using platform-of-opportunity data
Authors: Bouveroux Thibaut , Waggitt James J. , Belhadjer Anissa , Cazenave Pierre W. , Evans Peter G.H. , Kiszka Jeremy J.
Published: April 2020

Over the last 25 years, the harbour porpoise (Phocoena phocoena) has made a significant return to the Southern Bight of the North Sea and the English Channel due to a shift in distribution from northerly regions. Although the ecological drivers of this return are unclear, this species faces multiple threats in the region, including by-catch and habitat degradation. Ferry-based surveys were conducted year-round between November 2011 and June 2014 to assess the influence of environmental parameters upon the spatiotemporal distribution and relative abundance of harbour porpoises in the Southern Bight of the North Sea. A total of 1450 sightings of harbour porpoises were recorded during the 100 round-trip surveys carried out between Dunkirk (France) and Dover (England). Inter-annual and monthly variations in group size were observed, with largest groups recorded in 2014 (mean = 2.02) and in January (mean = 2.32). The relative abundance showed significant seasonal variation, with peaks recorded during winter months. An inter-annual increasing relative abundance was recorded during the study period. There was a seasonally dependent association with environmental variables, particularly depth, seabed roughness and current speed. Finally, predictions suggest large increases of the relative abundance in offshore habitats during winter months and over the study period.
Design of Automated Robotic System for Draping Prepreg Composite Fabrics
Authors: Ellekilde L.-P. , Wilm J. , Nielsen O. W. , Krogh C. , Kristiansen E. , Gunnarsson G. G. , Stenvang T. S. , Jakobsen J. , Kristiansen M. , Glud J. A. , Hannemose M. , Aanæs H. , de Kruijk J. , Sveidahl I. , Ikram A. , Petersen H. G.
Published: April 2020

This paper presents a novel solution for precision draping of prepreg composite fabrics onto double curved molds. Our contributions relate to system design, including hardware and software components, and to system integration. On the hardware side, design and implementation of a drape tool with up to 120 suction cups positioned individually by linear actuators are described. On the software side, design and implementation of the software architecture are presented, along with necessary algorithms within sensor technologies and mathematical modeling. The essential system’s components were verified individually, and the entire integrated system was successfully validated in the Proof-of-Concept experiments, performed on an experimental physical model of the system.
106 “Random Twitching” - A Case Presentation
Authors: Ruege Andrew
Published: April 2020

Purpose of the study:

To present a case about a 12 year old with a movement disorder to educate the community about an uncommon side effect of a commonly utilized class of psychiatric medications. Simple statement of methods: Patient was seen in the context of a consultation-liaison psychiatry capacity during the first author’s general psychiatry residency. Information was obtained from an electronic medical record and interviews with other physicians that treated the patient. Research about the patient’s supposed diagnosis was conducted using a PubMed + OneSearch searches and articles were obtained under the guidance of a certified hospital librarian.

Results/Discussion:

Withdrawal Emergent Dyskinesia is an uncommon, but debilitating condition that can occur after a rapid discontinuation/dosage change of a neuroleptic. This condition has been documented sparsely in the literature; more literature exists regarding its presence in children than in adults. The condition lasts for 2-3 months and resolves spontaneously in ~90% of cases. The literature that is available suggests (1) avoiding neuroleptic use in children if possible, (2) tapering off antipsychotics slowly, (3) using benzodiazepines and/or beta-blockers to treat symptoms of this condition, and (4) restarting the neuroleptic if symptoms do not improve.

Conclusion:

Withdrawal Emergent Dyskinesia is an uncommon, poorly studied, debilitating condition that can occur after a rapid discontinuation/dosage change of a neuroleptic. Future research efforts could be focused on (a) the prevalence of neuroleptic withdrawal symptoms in both adults and children, (b) the complete neurochemical and neurobiological pathogenesis of WED, and (c) the differences in terms of diagnosis and treatment between dyskinesias associated with both neuroleptic use and/or withdrawal. In addition, the existence of such a condition is yet another reason to reconsider off-label use of neuroleptics to treat behavioral symptoms in the absence of clear psychiatric indications for their use.
109 Hyperthyroidism-induced Psychosis
Authors: Shaikh Asad , Shah Khushbu , Idowu Joel
Published: April 2020

Objective:

To describe the presence of psychotic symptomatology in a patient with hyperthyroidism

Psychiatric-spectrum symptoms associated with thyrotoxicosis has been well reported in the past. However, psychosis in a patient with a thyroid nodule is a rare find. Here, the case of twenty four-year-old, single, unemployed, Albanian American male with self-reported history of Attention Deficit Disorder (ADD) and Cannabis use disorder was brought in to the Comprehensive Psychiatric Emergency Program (CPEP) due to new onset psychosis. Patient was paranoid, disorganized with labile mood. He had poor insight, judgement and impulse control. The event coincided with a period of unemployment in his life and new onset of hallucinations from past few days. He was brought in to the hospital after he was found pacing and having lack of sleep. Patient was treated with antipsychotic for acute psychosis. He was started on Risperidone initially to which he did not respond to. Blood work showed low TSH and elevated T4. Physical exam was noted for palpable thyroid nodule. Further labs resulted in high thyroid peroxidase antibody. Ultrasound of thyroid with color flow showed single nodule in the left lobe and iodine uptake activity localized to the left lobe. Patient was started on Methimazole 5 mg along with Haldol 5mg orally twice a day which improved his symptoms tremendously. Patient was stabilized and after 1 week was discharged on Haldol 5 mg by mouth two times a day for Psychosis, Cogentin 1 mg by mouth two times a day for extrapyramidal system (EPS), and Methimazole 5 mg by mouth daily for overactive thyroid nodule.

Conclusion:

Psychosis associated with thyroid nodule is rare but possible. The onset of psychotic syndrome is an important clinical element whose underlying medical cause must be promptly clarified. Psychosis can present in a number of ways and can have different causes. Apart from psychiatric causes, underlying medical causes should always be considered. In this case it was important to get a full clinical history of the patient as well as complete physical examination. The differential diagnosis of a psychotic disorder in light of a medical disease should always be considered in order to promptly diagnose and treat the underlying cause to reduce the morbidity and possibly the mortality associated with it.
130 Temporal Lobe Epilepsy: Is It in Your Differential Diagnosis? Two Case Reports
Authors: Avery Debra K , Min. Julie Brann D.
Published: April 2020

Temporal Lobe Epilepsy:

Is it in your differential diagnosis? Two Case Reports

Objective:

Temporal Lobe Epilepsy (TLE), also referred as Complex Partial Seizures, is a medical diagnosis that must be considered in the pediatric, adolescent, and adult population presenting for psychiatric care. Mood disorders are common in people with epilepsy, with a prevalence rate of 20 to 50%. Scant literature exists that seeks specifically to enhance our knowledge of the similarities and subtle differences between TLE, Bipolar Disorder (BD) and Post Traumatic Stress Disorder (PTSD). Our objective is to describe an adolescent and adult case; one initially diagnosed as BD, the other PTSD, when in fact, it was TLE. We aim to illustrate that misdiagnosis and failure to diagnose are common. The provider must engage in a thorough review of systems and consider TLE in the differential diagnosis. A delay in the appropriate diagnosis and treatment can lead to a substantial amount of adverse effects and worsening of symptoms and negatively impact one’s quality of life.

Method:

Two case studies; an adolescent and one adult, diagnosed with BD and the other PTSD. Both endorsed a history of symptoms indicative of TLE. Key assessment findings and screening diagnostics alerted us to the differential diagnosis of TLE. The overlap of the symptom presentation is described.

Results:

TLE and many psychiatric conditions often present with overlapping symptoms. Patients have the potential to present with absence seizures, unprovoked irritability, oppositionality, aggression, anger, paroxysmal anxiety, somatic symptoms such as headaches, nausea, burning in the abdomen, stereotyped movements or behaviors, hypergraphia bizarre or incongruous affect, symptoms of fear, disturbed sleep, tearfulness, memory problems, déjà vu, fugue states, changes in cognition, inability to concentrate, fatigue, auditory and visual hallucination and bad temper.

Our differential diagnosis of TLE was confirmed with electroencephalogram (EEG). By prescribing the appropriate medications to these two individuals, they were able to experience improved moods, become more productive in society, working, attending church, family outings, etc. They were weaned off their antipsychotic medications, of which an abundance of troubling side effects is now a non-issue.

Conclusions:

A delay in the proper diagnosis of TLE can have a significant negative impact on the adolescent and adult population. A need exists to educate mental health professionals on the overlap of symptoms of TLE and psychiatric disorders. The significant issue at hand is that they may not be receiving adequate or appropriate medications. Considering TLE in the differential diagnosis of presenting mood instability ensures our patients they are getting the basics of psychiatric care; which always emphasizes ruling out medical conditions first.
143 A Combination of Olanzapine and Samidorphan Has No Clinically Relevant Effect on QT Prolongation up to Supratherapeutic Doses
Authors: Sun Lei , Yagoda Sergey , Xue Hongqi , Brown Randy , Nangia Narinder , McDonnell David , Rege Bhaskar , von Moltke Lisa , Darpo Borje
Published: April 2020

Background:

ALKS 3831, a combination of olanzapine and samidorphan (OLZ/SAM) in development for schizophrenia, is intended to mitigate olanzapine-associated weight gain. This thorough QT (tQT) study evaluated OLZ/SAM effects on electrocardiogram parameters.

Methods:

In this randomized, double-blind, parallel-group study, 100 patients with stable schizophrenia were randomized 3:2 to either receive OLZ/SAM 10/10 mg (therapeutic dose) on days 2–4, 20/20 mg on days 5–8, and 30/30 mg (supratherapeutic dose) on days 9–13 with moxifloxacin-matching placebo on days 1 and 14, or a single dose of moxifloxacin 400 mg and matching placebo on days 1 and 14 (nested crossover design). Drug concentration relation to change from baseline in Fridericia-corrected QTc (ΔQTcF) was evaluated using a linear mixed-effect concentration-QTc (C-QTc) model. Adverse events were assessed.

Results:

The slope (90% CI) of the C-QTc was not significant for olanzapine or samidorphan (0.03 [−0.01, 0.08] and 0.01 [−0.01, 0.04] msec per ng/mL, respectively). Predicted placebo-corrected ΔQTcF (90% CI) was 2.33 (−2.72, 7.38) and 1.38 (−3.37, 6.12) msec at the observed geometric mean maximal concentration of olanzapine (62.6 ng/mL) and samidorphan (75.1 ng/mL), respectively, on day 13. A clinically relevant QT effect (ie, placebo-corrected ΔQTcF ≥10 msec) can be excluded for olanzapine and samidorphan concentrations up to ≈110 and ≈160 ng/mL, respectively. Assay sensitivity was confirmed by the C-QTc relationship of moxifloxacin. OLZ/SAM was well tolerated.

Conclusions:

OLZ/SAM, in doses and plasma concentrations up to supratherapeutic levels, was well tolerated and had no clinically relevant effects on electrocardiogram parameters, including QT interval, in patients with schizophrenia.

Funding Acknowledgements:

This study was funded by Alkermes, Inc.
182 The Brain Becomes What the Brain Does
Authors: Callahan Vince
Published: April 2020

The lack of current research regarding teacher knowledge about early life stress (ELS) in children needs to be expanded. The purpose of this study was to assess teacher knowledge, educational training levels, and their individual ability to identify signs and symptoms of ELS. Participants were given the Early Life Stress Assessment Survey. The statistical analysis of respondent survey data indicated that 85% of survey participants had little or no knowledge of the topic and have not attended at least one professional training course or seminar. This result was significant, because 96% of participating teachers indicated they had students who have experienced ELS in their classrooms. Additionally, participants were asked to identify signs and symptoms of ELS versus other types of learning disabilities. The average survey score was 58% correct answers.
187 Between a Rock and a Hard Place: Challenges in Treating Patient with Phagophobia and Comorbid Panic Disorder and Severe Anorexia
Authors: Yen Po Yu , Akram Faisal , Naqvi Syed
Published: April 2020

Phagophobia is a rare form of psychogenic dysphagia; it is characterized by an intense fear of swallowing food. It is a disorder which may be potentially life threatening if left untreated. Different effective approaches regarding the management for phagophobia have been documented in the past. However, there have not been sufficient data to support a definitive treatment. We would like to present a case which phagophobia, along with the presence of panic disorder and severe anorexia increase the difficulty in patient management.

Patient is a middle-aged female with history of anorexia nervosa and panic disorder. She presented with an eight-month history of inadequate caloric intake which was related to her fear of gaining weight and being preoccupied with intense fear of intake of food and medications; she stated that her throat was burning in attempt to swallow solids. She also stated that she felt like she had a “lump” in the throat. Her intake of food was limited to only certain types of food. However, after eating, she would engage in purging behaviors. Her hospitalization was complicated by multiple panic attacks in a day.

Patient underwent diagnostic interventions that helped us ruled out the other underlying causes of her symptoms: physical examinations, laboratory findings, bedside swallowing evaluation and esophagogastroduodenoscopy. These evaluations indicated that her symptoms were not caused by a medical condition or physiological effects of a substance. Daily medications aided with Anxiolytics as needed were prescribed for managing her symptoms. Non- pharmacological managements following the recommendations of the expert in positive behavior support were performed aiming to treat her symptoms.

Due to intense fear of swallowing, she was not able to take oral medications for panic disorder, and the effect of psychotherapy for eating disorder was limited due to frequent recurrence of panic attacks. She had not shown improvement of her symptoms: inadequate daily energy intake and medication, non-compliance to oral medications. Her BMI dropped from 14 to 13 over the course of 8 months and the symptoms of panic disorder persisted, and she is at risk of medical emergencies.

In this report, we present the challenges in managing a patient with multiple psychiatric comorbidities, where each illness increased the difficulty of treating another illness. We had reviewed case reports which indicated that cognitive behavioral techniques may be beneficial to patients with phagophobia. However, the effects of non-pharmacological managements were limited as patient’s psychiatric illness prevented her from completing each session. To this date, there has been no report of treatment success in a patient whose situation is similar to hers. Further research, clinical trials, and additional data collected in the future may provide new insights into management of this therapeutic challenge.
Early childhood malnutrition trajectory and lung function at preadolescence
Authors: Ferdous Farzana , Raqib Rubhana , Ahmed Sultan , Faruque ASG , Chisti Mohammod J , Ekström Eva-Charlotte , Wagatsuma Yukiko
Published: April 2020

Objective:

Chronic undernutrition is a common phenomenon in Bangladesh. However, information is grossly lacking to report the correlation between chronic undernutrition trajectory and lung function in children. The aim of the current study was to understand the association between early-childhood chronic undernutrition trajectory and lung function at preadolescence.

Design:

The current study is a part of the 9-year follow-up of a large-scale cohort study called the Maternal and Infant Nutrition Interventions in Matlab.

Settings:

The current study was conducted in Matlab, a sub-district area of Bangladesh that is located 53 km south of the capital, Dhaka.

Participants:

A total of 517 children participated in lung function measured with a spirometer at the age of 9 years. Weight and height were measured at five intervals from birth till the age of 9 years.

Results:

Over half of the cohort have experienced a stunting undernutrition phenomenon up to 9 years of age. Children who were persistently or intermittently stunted showed lower forced expiratory volume (ml/s) than normal-stature children (P < 0·05). Children who exhibited catch-up growth throughout 4·5 years from the stunted group showed similar lung function with normal counterparts, and a better lung function than in children with the same growth velocity or who had faltering growth. In the multivariable models, similar associations were observed in children who experienced catch-up growth than their counterparts after adjusting for covariates.

Conclusion:

Our data suggest that catch-up growth in height during early childhood is associated with a better lung function at preadolescence.
A new method for risk factor assessment of organs at risk including conformity index in radiotherapy treatment plan
Authors: Ansari Shahanawaj , Zope Mukesh Kumar , Yadav Neha
Published: April 2020

Introduction:

A comprehensive analysing method has been required since long in the field of radiotherapy. The basic purpose of all techniques has been to deliver the prescribed dose safely to the target volume containing tumour and as well as to reduce dose to organs at risk (OARs). The detailed comparison between different treatment techniques is very difficult and inexplicit as well. The gradual improvement in imaging software has made easy to users to assess spatial arrangement of tumour, critical organs and isodose lines in the form of a single 3D representation that can be observed from all angles. The conformity index (CI) alone cannot provide practical information about treatment plans as it is a single isodose line quantity.

Aim:

The aim of this study was to develop a new method to assess the degree of damage numerically for OARs along with CI assessment for the target.

Materials and Methods:

The radiotherapy plans of 30 patients of different sites, diagnosed as cancer, were selected for this study irrespective of gender. Out of 30 cases, 8 plans were of head and neck, 2 were of glyoblastoma (GBM), 10 were of pelvis, 5 were of left breast and other 5 were of oesophagus cancer. The mean age was 42 years ranging from 31 to 72 years. Patient’s consents were taken before starting the treatment and carried out this research. Risk factor (RF) for OARs depends on volume of irradiation (VVOI), total volume of the organ (VTVO) and tolerance dose (DTDO). All radiotherapy plans (Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT)) were generated using eclipse planning system, version 11.0 (Varian Medical System, Palo Alto, California, USA).

Result:

The formula developed to assess degree of damage of OARs including CI of the target is risk factor conformity index (RFC) = CI + RF. In head and neck cases, for right parotid, the maximum value of RF is 1·50 and minimum value is observed as 0·97. Optic nerve, brainstem and spinal cord are completely safe as their RF values are found to be 0 on RF scale.

Conclusion:

RFC is a comprehensive evaluation tool encompassing a wider range of clinically relevant parameters, isodose volumes and tolerance dose of OARs. It is an advance analysing method to check both the qualitative and quantitative nature of a conformal plan, and at the same time, it assesses the degree of damage of OARs.

If RF ≥ 1, then OAR will be completely damaged as a result of irradiation.

If RF = 0, then OAR will remain safe totally during the course of irradiation.
“Spinnin' the Webb”: Representational Spaces, Mythic Narratives, and the 1937 Webb/Goodman Battle of Music
Authors: WELLS CHRISTOPHER J.
Published: April 2020

Benny Goodman and Chick Webb's 1937 battle of music has become a mythic event in jazz historical narratives, enshrined as the unique spectacle that defines Harlem's Savoy Ballroom and its legacy. While this battle has been marked as exceptional and unique, as an event it was a relatively typical instantiation of the “battle of music” format, a presentational genre common in black venues during the 1920s and 1930s. Within African American communities, battles of music re-staged ballrooms as symbolically loaded representational spaces where dueling bands regularly served as oppositional totems that indexed differences of locality (Chicago vs. New York), gender (men vs. women), ethnicity (Anglo- or African American vs. Latin), or race (black vs. white). This article details the ten-year history of battles of music that preceded the Webb/Goodman battle and that made its signifying rhetoric legible within African American communities. It then argues that the disconnect between the battle's relatively typical signifying rhetoric and its subsequent enshrinement as an exceptional event occurred due to a specific confluence of circumstances in the mid-1930s that shaped its immediate reception and subsequent legacy: Goodman's emergence as the “King of Swing” during a new period of massive mainstream popularity for swing music, a coterminous vigilance among both white and black jazz writers to credit black artists as jazz's originators and best practitioners, and the emergence of athletes Jesse Owens and Joe Louis as popular black champions symbolically conquering white supremacy at home and abroad.
Type-2 diabetes and risk of dementia: observational and Mendelian randomisation studies in 1 million individuals
Authors: Thomassen Jesper Qvist , Tolstrup Janne Schurmann , Benn Marianne , Frikke-Schmidt Ruth
Published: April 2020

Aims

In observational studies, type-2 diabetes is associated with increased risk of dementia; however, the causal nature of this association remains unanswered. In an unselected nationwide study of all Danes, we wanted to test whether type-2 diabetes is associated with dementia subtypes, and to test whether potential associations are of a causal nature.

Methods

In the current study of nationwide observational registry data in all Danes above the age of 65 years (n= 784 434) combined with genetic consortia data on 213 370 individuals, we investigated the associations between type-2 diabetes and Alzheimer's disease, vascular dementia, unspecified dementia and all-cause dementia, and whether observational associations were of a causal nature by applying a two-sample Mendelian randomisation strategy. We addressed key biases inherent in Mendelian randomisation approaches.

Results

Important confounders (age, ethnicity, size of community, region, civil status and education level) were captured on all 784 434 individuals and adjusted for in the models. Multifactorial adjusted hazard ratios were 1.13 (1.06–1.21) for Alzheimer's disease, 1.98 (1.83–2.14) for vascular dementia, 1.53 (1.48–1.59) for unspecified dementia and 1.48 (1.44–1.53) for all-cause dementia in persons with type-2 diabetesv. without. Results were similar for men and women. The two-sample Mendelian randomisation estimate for the association between the genetic instrument and Alzheimer's disease was 1.04 (0.98–1.10), consistent with sensitivity estimates, addressing pleiotropy, measurement bias and weak instrument bias.

Conclusions

In a nationwide study of all Danes above the age of 65 years, we show that type-2 diabetes is associated with major subtypes of dementia – with particularly strong associations for vascular dementia and unspecified dementia – the two types of dementia with the most obvious vascular pathologies. Although the present two-sample Mendelian randomisation approach using genetic consortia data suggests that type-2 diabetes is not a direct cause of Alzheimer's disease, we were unable to test the causal nature of type-2 diabetes for vascular dementia and unspecified dementia, because no publicly available genetic consortia data yet exist for these dementia endpoints. The causal nature of type-2 diabetes for dementia with vascular pathologies is pivotal questions to solve for future public health recommendations and therapeutic advice.
Methods for Estimating Wet Bulb Globe Temperature From Remote and Low‐Cost Data: A Comparative Study in Central Alabama
Authors: Carter Anabel W. , Zaitchik Benjamin F. , Gohlke Julia M. , Wang Suwei , Richardson Molly B.
Published: April 2020

Heat stress is a significant health concern that can lead to illness, injury, and mortality. The wet bulb globe temperature (WBGT) index is one method for monitoring environmental heat risk. Generally, WBGT is estimated using a heat stress monitor that includes sensors capable of measuring ambient, wet bulb, and black globe temperature, and these measurements are combined to calculate WBGT. However, this method can be expensive, time consuming, and requires careful attention to ensure accurate and repeatable data. Therefore, researchers have attempted to use standard meteorological measurements, using single data sources as an input (e.g., weather stations) to calculate WBGT. Building on these efforts, we apply data from a variety of sources to calculate WBGT, understand the accuracy of our estimated equation, and compare the performance of different sources of input data. To do this, WBGT measurements were collected from Kestrel 5400 Heat Stress Trackers installed in three locations in Alabama. Data were also drawn from local weather stations, North American Land Data Assimilation System (NLDAS), and low cost iButton hygrometers. We applied previously published equations for estimating natural wet bulb temperature, globe temperature, and WBGT to these diverse data sources. Correlation results showed that WBGT estimates derived from all proxy data sources—weather station, weather station/iButton, NLDAS, NLDAS/iButton—were statistically indistinguishable from each other, or from the Kestrel measurements, at two of the three sites. However, at the same two sites, the addition of iButtons significantly reduced root mean square error and bias compared to other methods.
Stratocumulus in the Cold and Warm Sides of the Spring Kuroshio Sea Surface Temperature Front in the East China Sea
Authors: Zhang Zhiwei , Li Yunying , Song Wenting
Published: April 2020

The characteristics and formation mechanisms of stratocumulus (Sc) clouds were investigated in this study based on satellite and sounding data from March and April 2007–2010. The effects of the intensity of the Kuroshio sea surface temperature (SST) front on the amount and height of Sc clouds were also assessed by composite analysis. Sc clouds mainly occurred lower than 3 km as single‐layer clouds, and there was a larger amount of clouds in the warm side than in the cold side of the Kuroshio area. This difference occurred because the Kuroshio SST front produced different dynamics and thermal structures in the planetary boundary layer (PBL) of the warm and cold sides. Both the strong local sensible heat flux forced by strong northwesterly winds and the large relative humidity in the PBL favored the formation of Sc clouds in the warm side. In the cold side, both the strong temperature inversion caused by downdrafts and the PBL top height hindered cloud development, similar to the cloud formation conditions in the subtropical oceans near California. Furthermore, the amount and height of clouds were influenced by the Kuroshio SST front intensity. In the warm side, more abundant clouds and a higher cloud height were associated with a strong SST front background than with a weak SST front background.
A Channel Network Model for Sediment Dynamics Over Watershed Management Time Scales
Authors: Beveridge Claire , Istanbulluoglu Erkan , Bandaragoda Christina , Pfeiffer Allison M.
Published: April 2020

A mountain watershed network model is presented for use in decadal to centurial estimation of source‐to‐sink sediment dynamics. The model requires limited input parameters and can be effectively applied over spatial scales relevant to management of reservoirs, lakes, streams, and watersheds (1–100 km2). The model operates over a connected stream network of Strahler‐ordered segments. The model is driven by streamflow from a physically based hydrology model and hillslope sediment supply from a stochastic mass wasting algorithm. For each daily time step, segment‐scale sediment mass balance is computed using bedload and suspended load transport equations. Sediment transport is partitioned between grain size fractions for bedload as gravel and sand, and for suspended load as sand and mud. Bedload and suspended load can deposit and re‐entrain at each segment. We demonstrated the model in the Elwha River Basin, upstream of the former Glines Canyon dam, over the dam's historic 84‐year lifespan. The model predicted the lifetime reservoir sedimentation volume within the uncertainty range of the measured volume (13.7–18.5 million m3) for 25 of 28 model instances. Gravel, sand, and mud fraction volumes were predicted within measurement uncertainty ranges for 18 model instances. The network model improved the prediction of sediment yields compared to at‐a‐station sediment transport capacity relations. The network model also provided spatially and temporally distributed information that allowed for inquiry and understanding of the physical system beyond the sediment yields at the outlet. This work advances cross‐disciplinary and application‐oriented watershed sediment yield modeling approaches.