bluuebunny/crossref_metadata_2025 huggingface dataset:
Abdominal Pain and Anxious or Depressed State Are Independently Associated With Weight Loss in Inflammatory Bowel Disease
Authors: Gorrepati Venkata Subhash , Soriano Christopher , Johri Ansh , Dalessio Shannon , Stuart August , Koltun Walter , Tinsley Andrew , Clarke Kofi , Williams Emmanuelle , Coates Matthew
Published: May 2020

Background

Many factors impact nutritional status in inflammatory bowel disease (IBD). We undertook this study to evaluate the potential role that abdominal pain has on weight loss and dietary behavior in IBD.

Methods

This is a retrospective cohort study utilizing data from an IBD registry at our institution between January 1, 2015 and August 31, 2018. Pain scores and nutritional outcomes were derived from validated questionnaires while key associated clinical data were derived from the medical record.

Results

Three hundred and three patients (154 females; 206 Crohn’s disease) were included in this study. Ninety-six patients (31.7%) had experienced a 6-lb or greater weight loss in the prior month. On multivariate analysis, abdominal pain and anxious/depressed state were independently associated with weight loss, while female gender and NSAID use were inversely associated with weight loss (P < 0.05). IBD patients with abdominal pain also reported significantly poorer dietary behavior than those without this symptom.

Conclusions

Abdominal pain is more likely to result in negative dietary outcomes and independently associated with weight loss in IBD. IBD providers should screen for malnutrition when patients report abdominal pain.
The group size effect and synchronization of vigilance in the Tibetan wild ass
Authors: Wang Xinxin , Yang Le , Zhao Yumeng , Yu Cong , Li Zhongqiu
Published: May 2020

Vigilance behavior is considered as an effective strategy for prey species to detect predators. An individual benefits from living in a group by reducing the time spent being vigilant without affecting the probability of detecting a predator. However, the mechanism producing a decrease in vigilance with increasing group size is unclear. Many models of vigilance assume that group members scan independently of one another. Yet in recent studies, the other 2 patterns of vigilance, coordination and synchronization, were reported in some species. In 2 summers (2018 and 2019), we studied the group-size effect on vigilance and foraging of Tibetan wild ass in Chang Tang Nature Reserve of Tibet. We also tested whether individuals scan the environment independently, tend to coordinate their scans, or tend to synchronize their vigilance. The results showed that individuals decreased the time spent on vigilance with increasing group size, while increased the time spent foraging. Group members scanned the environment at the same time more frequently and there was a positive correlation between group members’ behaviors, indicating that Tibetan wild asses tend to synchronize their vigilance.
Successful use of venovenous snare to fix the wire in a collateral vein for proper placement of the left ventricular lead during cardiac resynchronization therapy: a case report
Authors: Reddy Muni Venkatesa , Deshpande Saurabh Ajit , Roul Shishir Kumar , Udyavar Ameya
Published: May 2020

Background

In cardiac resynchronization therapy, left ventricular (LV) lead placement at the desired position may be difficult due to abnormal coronary sinus (CS) and lateral vein anatomy. We present a case with difficult anatomy in which we used ‘an indigenous snare’ made from hardware used for coronary angioplasty procedures, which is available in any cardiac catheterization laboratory.

Case summary

A 52-year-old man presented with dyspnoea due to chronic heart failure was evaluated for cardiac resynchronization therapy. The LV lead was difficult to advance into the only target lateral branch of the CS due to a combination of angulation and proximal stenosis. Balloon dilation was tried first, but we failed to track the LV lead. We formed a venovenous loop, advancing the coronary guidewire 0.014″ into the posterolateral vein; subsequently into the middle cardiac vein via a collateral. The wire was advanced into the CS and then to superior vena cava. The guidewire then snared through the same left subclavian vein and exteriorized by using indigenous snare. Over this loop, the LV lead of the cardiac resynchronization therapy with defibrillator device was implanted successfully.

Discussion

We have used the snare technique, with the use of a snare prepared from a coronary guidewire. Use of such an indigenous snare has not been described before in the literature. The hardware used in this case is routinely used for coronary angioplasty procedures in all catheterization labs. The importance of our case is that no special hardware like dedicated snare was required to negotiate the LV lead at its desired location.
Victims of medical errors and the problems they face: a prospective comparative study among the Dutch population
Authors: van der Velden Peter G , Contino Carlo , Akkermans Arno J , Das Marcel
Published: May 2020

Background

A large number of studies are devoted to medical errors, but only a few focused on the problem’s victims of these errors face. Prospective comparative studies on this topic are absent. The aim of this prospective comparative study is to fill this gap of scientific knowledge that may help to improve the care for victims.

Methods

Data were collected in the Longitudinal Internet studies for the Social Sciences panel, based on a random sample of the Dutch population. Surveys were conducted in March–April 2018 (T1response = 82.1%) and March–April 2019 (T2response = 80.1%). We assessed medical errors and potentially traumatic or stressful events between T1 and T2, and mental health, work, financial, religious, family, legal/administrative and physical problems at T1 and T2 (Ntotal = 4711).

Results

In total, 79 respondents were affected by medical errors between T1 and T2, and 2828 were not affected by any event. Of the victims, 28% had high PTSD symptom levels at T2. Stepwise multivariate logistic regression entering all problems at T1 and demographics showed that victims compared with controls significantly more often had all assessed problems at T2, except family problems. For instance, victims more often had mental health problems (29.5% vs. 9.3%; adj. OR = 3.04, P = 0.002) and financial problems (30.4% vs. 6.6%; adj. OR = 4.82, P < 0.001) at T2.

Conclusions

Victims of medical errors more often face various non-physical problems than others. Care for victims should therefore, besides physical health, also include the assessment and targeting of their problems regarding mental health, work, religion, legal issues and finance.
Transiently increased risk of breast cancer after childbirth: implications for fertility treatments and surrogacy
Authors: Blumenfeld Zeev , Gleicher Norbert , Adashi Eli Y
Published: May 2020

Whereas longstanding dogma has purported that pregnancies protect women from breast cancer, a recent meta-analysis now mandates reconsideration since it reported an actual higher breast cancer risk for more than two decades after childbirth before the relative risk turns negative. Moreover, the risk of breast cancer appears higher for women having their first birth at an older age and with a family history and it is not reduced by breastfeeding. The process of obtaining informed consent for all fertility treatments, therefore, must make patients aware of the facts that every pregnancy, to a small degree, will increase the short-term breast cancer risk. This observation may be even more relevant in cases of surrogacy where women agree to conceive without deriving benefits of offspring from assuming the risk, thus creating a substantially different risk-benefit ratio. Consequently, it appears prudent for professional societies in the field to update recommendations regarding consent information for all fertility treatments but especially for treatments involving surrogacy.
The Issue of Recurrently Positive Patients Who Recovered From COVID-19 According to the Current Discharge Criteria: Investigation of Patients from Multiple Medical Institutions in Wuhan, China
Authors: Zou You , Wang Bin-Ru , Sun Liu , Xu Shan , Kong Yong-Gang , Shen Li-Jun , Liang Geng-Tian , Chen Shi-Ming
Published: May 2020

The current discharge criteria for COVID-19 require that patients have 2 consecutive negative results for reverse transcription polymerase chain reaction (RT-PCR) detection. Here, we observed that recurrent positive RT-PCR test results in patients with 3 consecutive negative results (5.4%) were significantly decreased compared with those in patients with 2 consecutive negative results (20.6%); such patients reported positive RT-PCR test results within 1 to 12 days after meeting the discharge criteria. These results confirmed that many recovered patients could show a positive RT-PCR test result, and most of these patients could be identified by an additional RT-PCR test prior to discharge.
Peripheral Neuronopathy Associated With Ebola Virus Infection in Rhesus Macaques: A Possible Cause of Neurological Signs and Symptoms in Human Ebola Patients
Authors: Liu David X , Perry Donna L , Cooper Timothy K , Huzella Louis M , Hart Randy J , Hischak Amanda M W , Bernbaum John G , Hensley Lisa E , Bennett Richard S
Published: May 2020

Neurological signs and symptoms are the most common complications of Ebola virus disease. However, the mechanisms underlying the neurologic manifestations in Ebola patients are not known. In this study, peripheral ganglia were collected from 12 rhesus macaques that succumbed to Ebola virus (EBOV) disease from 5 to 8 days post exposure. Ganglionitis, characterized by neuronal degeneration, necrosis, and mononuclear leukocyte infiltrates, was observed in the dorsal root, autonomic, and enteric ganglia. By immunohistochemistry, RNAscope in situ hybridization, transmission electron microscopy, and confocal microscopy, we confirmed that CD68+ macrophages are the target cells for EBOV in affected ganglia. Further, we demonstrated that EBOV can induce satellite cell and neuronal apoptosis and microglial activation in infected ganglia. Our results demonstrate that EBOV can infect peripheral ganglia and results in ganglionopathy in rhesus macaques, which may contribute to the neurological signs and symptoms observed in acute and convalescent Ebola virus disease in human patients.
Performance of Severe Acute Respiratory Syndrome Coronavirus 2 Antibody Assays in Different Stages of Infection: Comparison of Commercial Enzyme-Linked Immunosorbent Assays and Rapid Tests
Authors: Traugott Marianna , Aberle Stephan Walter , Aberle Judith Helene , Griebler Hannah , Karolyi Mario , Pawelka Erich , Puchhammer-Stöckl Elisabeth , Zoufaly Alexander , Weseslindtner Lukas
Published: May 2020

We comparatively assessed sensitivities and specificities of 4 commercial enzyme-linked immunosorbent assays (ELISAs) and 2 rapid tests in 77 patients with polymerase chain reaction–confirmed severe acute respiratory syndrome coronavirus 2 infection, grouped by interval since symptom onset. Although test sensitivities were low (<40%) within the first 5 days after disease onset, immunoglobulin (Ig) M, IgA, and total antibody ELISAs increased in sensitivity to >80% between days 6 and 10 after symptom onset. The evaluated tests (including IgG and rapid tests) provided positive results in all patients at or after the 11th day after onset of disease. The specificities of the ELISAs were 83% (IgA), 98% (IgG), and 97% (IgM and total antibody).
Near-infrared photoimmunotherapy of cancer: a new approach that kills cancer cells and enhances anti-cancer host immunity
Authors: Kobayashi Hisataka , Furusawa Aki , Rosenberg Adrian , Choyke Peter L
Published: May 2020

Near-infrared photoimmunotherapy (NIR-PIT) is a recently developed hybrid cancer therapy that directly kills cancer cells as well as producing a therapeutic host immune response. Conventional immunotherapies, such as immune-activating cytokine therapy, checkpoint inhibition, engineered T cells and suppressor cell depletion, do not directly destroy cancer cells, but rely exclusively on activating the immune system. NIR-PIT selectively destroys cancer cells, leading to immunogenic cell death that initiates local immune reactions to released cancer antigens from dying cancer cells. These are characterized by rapid maturation of dendritic cells and priming of multi-clonal cancer-specific cytotoxic T cells that kill cells that escaped the initial direct effects of NIR-PIT. The NIR-PIT can be applied to a wide variety of cancers either as monotherapy or in combination with conventional immune therapies to further activate anti-cancer immunity. A global Phase 3 clinical trial (https://clinicaltrials.gov/ct2/show/NCT03769506) of NIR-PIT targeting the epidermal growth factor receptor (EGFR) in patients with recurrent head and neck cancer is underway, employing RM1929/ASP1929, a conjugate of anti-EGFR antibody (cetuximab) plus the photo-absorber IRDye700DX (IR700). NIR-PIT has been given fast-track recognition by regulators in the USA and Japan. A variety of imaging methods, including direct IR700 fluorescence imaging, can be used to monitor NIR-PIT. As experience with NIR-PIT grows, additional antibodies will be employed to target additional antigens on other cancers or to target immune-suppressor cells to enhance host immunity. NIR-PIT will be particularly important in patients with localized and locally advanced cancers and may help such patients avoid side-effects associated with surgery, radiation and chemotherapy.
A graph-based method for reconstructing entities from coordination ellipsis in medical text
Authors: Yuan Chi , Wang Yongli , Shang Ning , Li Ziran , Zhao Ruxin , Weng Chunhua
Published: May 2020

Objective

Coordination ellipsis is a linguistic phenomenon abound in medical text and is challenging for concept normalization because of difficulty in recognizing elliptical expressions referencing 2 or more entities accurately. To resolve this bottleneck, we aim to contribute a generalizable method to reconstruct concepts from medical coordinated elliptical expressions in a variety of biomedical corpora.

Materials and Methods

We proposed a graph-based representation model and built a pipeline to reconstruct concepts from coordinated elliptical expressions in medical text (RECEEM). There are 4 modules: (1) identify all possible candidate conjunct pairs from original coordinated elliptical expressions, (2) calculate coefficients for candidate conjuncts using the embedding model, (3) select the most appropriate decompositions by global optimization, and (4) rebuild concepts based on a pathfinding algorithm. We evaluated the pipeline’s performance on 2658 coordinated elliptical expressions from 3 different medical corpora (ie, biomedical literature, clinical narratives, and eligibility criteria from clinical trials). Precision, recall, and F1 score were calculated.

Results

The F1 scores for biomedical publications, clinical narratives, and research eligibility criteria were 0.862, 0.721, and 0.870, respectively. RECEEM outperformed 2 previously released methods. By incorporating RECEEM into 2 existing NLP tools, the F1 scores increased from 0.248 to 0.460 and from 0.287 to 0.630 on concept mapping of 1125 coordination ellipses.

Conclusions

RECEEM improves concept normalization for medical coordinated elliptical expressions in a variety of biomedical corpora. It outperformed existing methods and significantly enhanced the performance of 2 notable NLP systems for mapping coordination ellipses in the evaluation. The algorithm is open sourced online (https://github.com/chiyuan1126/RECEEM).
Evaluation of safety and diagnostic performance for flexible hysteroscopy in 1591 outpatient cases
Authors: Kobayashi Yusuke , Tsuji Kosuke , Nakamura Kanako , Nagai Shimpei , Takahashi Takayuki , Kobayashi Arata , Anko Mayuka , Hirano Takuro , Watanabe Keiko , Matoba Yusuke , Kunitomi Haruko , Adachi Masataka , Yamagami Wataru , Tominaga Eiichiro , Banno Kouji , Aoki Daisuke
Published: May 2020

Background

To date, only few large studies are available concerning the safety and diagnostic concordance rates of outpatient flexible hysteroscopy. In our institution, outpatient hysteroscopy has been routinely and educationally applied Kosuke Tsuji to intrauterine lesions; thus, we retrospectively investigated the institution’s outpatient flexible hysteroscopy cases.

Methods

A total of 1591 cases of outpatient flexible hysteroscopy conducted at our institution in 2012–2016 were retrospectively analyzed in terms of their clinical background, complications and diagnostic concordance rates.

Results

A total of 1591 cases included 546 cases of benign tumors (317 endometrial polyps, 168 myomas and 61 endometrial hyperplasia), 361 cases of atypical endometrial hyperplasia, 571 cases of endometrial cancers and 113 cases of other diagnoses. No major complications, including uterine perforation, occurred. However, one patient (0.06%) was diagnosed with septic shock caused by intrauterine infection that required prolonged immunosuppressive drug administration. Meanwhile, 335 patients diagnosed with benign tumors through outpatient flexible hysteroscopy underwent operation, and the diagnostic concordance rate was 74.6% (250 cases). However, this rate included 14 cases (4.2%) diagnosed with malignant tumors postoperatively. In preoperative endometrial cancer cases, the sensitivity and specificity for cervical invasion diagnosis were 39.4 and 90.8%, respectively. In addition, only one patient manifested positive ascites cytology intraoperatively, possibly caused by outpatient hysteroscopy.

Conclusions

Outpatient flexible hysteroscopy is highly safe, with a slight negligible effect on ascites cytology. However, the diagnosis should be determined by multidisciplinary approaches, as hysteroscopy alone can miss malignancy.
Critical Media Effects Framework: Bridging Critical Cultural Communication and Media Effects through Power, Intersectionality, Context, and Agency
Authors: Ramasubramanian Srividya , Banjo Omotayo O
Published: May 2020

In this essay, we advance the Critical Media Effects (CME) framework as a way of bridging two major subfields of communication that seldom speak to one another: media effects scholarship and critical cultural communication. Critical Media Effects is situated within the dominant mode of social scientific theorizing within media effects scholarship and draws on four key interrelated concepts from critical cultural communication: power, intersectionality, context, and agency. Critical Media Effects advocates for greater reflexivity, rigor, and nuance in theorizing about media effects to better respond to the complexity and dynamicity of emerging global sociopolitical mediated contexts. Recommendations, salient examples, and future directions for co-creating a shared research roadmap for CME are discussed. Through this work of bridging, we hope to promote more collaborative partnerships, productive engagement, and mutual solidarity across these two important subfields to address the most pressing social issues and challenges of the world today.
Space and time complexity for infinite time Turing machines
Authors: Carl Merlin
Published: May 2020

We consider notions of space by Winter [21, 22]. We answer several open questions about these notions, among them whether low space complexity implies low time complexity (it does not) and whether one of the equalities P=PSPACE, P$_{+}=$PSPACE$_{+}$ and P$_{++}=$PSPACE$_{++}$ holds for ITTMs (all three are false). We also show various separation results between space complexity classes for ITTMs. This considerably expands our earlier observations on the topic in Section 7.2.2 of Carl (2019, Ordinal Computability: An Introduction to Infinitary Machines), which appear here as Lemma $6$ up to Corollary $9$.
Accelerated Bayesian inference using deep learning
Authors: Moss Adam
Published: May 2020

We present a novel Bayesian inference tool that uses a neural network (NN) to parametrize efficient Markov Chain Monte Carlo (MCMC) proposals. The target distribution is first transformed into a diagonal, unit variance Gaussian by a series of non-linear, invertible, and non-volume preserving flows. NNs are extremely expressive, and can transform complex targets to a simple latent representation. Efficient proposals can then be made in this space, and we demonstrate a high degree of mixing on several challenging distributions. Parameter space can naturally be split into a block diagonal speed hierarchy, allowing for fast exploration of subspaces where it is inexpensive to evaluate the likelihood. Using this method, we develop a nested MCMC sampler to perform Bayesian inference and model comparison, finding excellent performance on highly curved and multimodal analytic likelihoods. We also test it on Planck 2015 data, showing accurate parameter constraints, and calculate the evidence for simple one-parameter extensions to the standard cosmological model in ∼20D parameter space. Our method has wide applicability to a range of problems in astronomy and cosmology and is available for download from https://github.com/adammoss/nnest.
A high-resolution view of the jets in 3C 465
Authors: Bempong-Manful E , Hardcastle M J , Birkinshaw M , Laing R A , Leahy J P , Worrall D M
Published: May 2020

We present new high-resolution and high-sensitivity studies of the jets in the WAT source 3C 465, using deep transverse-resolved radio observations from e-MERLIN, and with complementary observations from the Very Large Array (VLA). We derive a lower limit βj = (νj/c) ≳ 0.5 for the jet speed, and an upper limit $\theta _{\rm j}\, \lesssim$ 61° for the jet angle to the line of sight. The jet spectral index (α, defined in the sense S ∝ να) is fairly constant (<αjet > = − 0.7), and spectral flattening within 4.4 kpc of the core coincides with bright knots and is consistent with the site of X-ray particle acceleration at the base of the radio jet found in previous studies. There is little difference between the spectra of the two hotspot components, plausibly indicating that electron populations of the same properties are injected there. The north-west (NW) and south-east (SE) plumes are approximately homologous structures, with variations in mass injection and propagation in external pressure and density gradients in the two regions plausibly accounting for the slightly steeper spectrum in the NW plume, <αNWp> = −1.43 compared with the SE plume, <αSEp> = −1.38. Our synchrotron lifetime model supports plausible reacceleration of particles within the plume materials. Overall, our results show that the first-order Fermi process at mildly relativistic and non-relativistic shocks is the most likely acceleration mechanism at play in 3C 465 and distinguish differences between the acceleration at $\beta _{\rm j}\, \gt $ 0.5 and $\beta _{\rm j}\, \lt $ 0.5. The former case can accelerate electrons to higher Lorentz factors.
Differentiable strong lensing: uniting gravity and neural nets through differentiable probabilistic programming
Authors: Chianese Marco , Coogan Adam , Hofma Paul , Otten Sydney , Weniger Christoph
Published: May 2020

Since upcoming telescopes will observe thousands of strong lensing systems, creating fully automated analysis pipelines for these images becomes increasingly important. In this work, we make a step towards that direction by developing the first end-to-end differentiable strong lensing pipeline. Our approach leverages and combines three important computer science developments: (i) convolutional neural networks (CNNs), (ii) efficient gradient-based sampling techniques, and (iii) deep probabilistic programming languages. The latter automatize parameter inference and enable the combination of generative deep neural networks and physics components in a single model. In the current work, we demonstrate that it is possible to combine a CNN trained on galaxy images as a source model with a fully differentiable and exact implementation of gravitational lensing physics in a single probabilistic model. This does away with hyperparameter tuning for the source model, enables the simultaneous optimization of nearly 100 source and lens parameters with gradient-based methods, and allows the use of efficient gradient-based posterior sampling techniques. These features make this automated inference pipeline potentially suitable for processing a large amount of data. By analysing mock lensing systems with different signal-to-noise ratios, we show that lensing parameters are reconstructed with per cent-level accuracy. More generally, we consider this work as one of the first steps in establishing differentiable probabilistic programming techniques in the particle astrophysics community, which have the potential to significantly accelerate and improve many complex data analysis tasks.
Shock within a shock: revisiting the radio flares of NS merger ejecta and gamma-ray burst-supernovae
Authors: Margalit Ben , Piran Tsvi
Published: May 2020

Fast ejecta expelled in binary neutron star (NS) mergers or energetic supernovae (SNe) should produce late-time synchrotron radio emission as the ejecta shocks into the surrounding ambient medium. Models for such radio flares typically assume the ejecta expands into an unperturbed interstellar medium (ISM). However, it is also well known that binary NS mergers and broad-lined Ic SNe Ic can harbour relativistic jetted outflows. In this work, we show that such jets shock the ambient ISM ahead of the ejecta, thus evacuating the medium into which the ejecta subsequently collides. Using an idealized spherically symmetric model, we illustrate that this inhibits the ejecta radio flare at early times $t \lt t_{\rm col} \approx 12 \, {\rm yr} \, (E_{\rm j}/10^{49} \, {\rm erg})^{1/3} (n/1 \, {\rm cm}^{-3})^{-1/3} (\upsilon _{\rm ej}/0.1c)^{-5/3}$, where Ej is the jet energy, n the ISM density, and $\upsilon$ej the ejecta velocity. We also show that this can produce a sharply peaked enhancement in the light curve at t = tcol. This has implications for radio observations of GW170817 and future binary NS mergers, gamma-ray burst (GRB) SNe, decade-long radio transients such as FIRST J1419, and possibly other events where a relativistic outflow precedes a slower moving ejecta. Future numerical work will extend these analytic estimates and treat the multidimensional nature of the problem.
Which Method of Assessing Depression and Anxiety Best Predicts Smoking Cessation: Screening Instruments or Self-Reported Conditions?
Authors: Watson Noreen L , Heffner Jaimee L , Mull Kristin E , McClure Jennifer B , Bricker Jonathan B
Published: May 2020

Introduction

Affective disorders and symptoms (ADS) are predictive of lower odds of quitting smoking. However, it is unknown which approach to assessing ADS best predicts cessation. This study compared a battery of ADS screening instruments with a single, self-report question on predicting cessation. Among those who self-reported ADS, we also examined if an additional question regarding whether participants believed the condition(s) might interfere with their ability to quit added predictive utility to the single-item question.

Methods

Participants (N = 2637) enrolled in a randomized controlled trial of web-based smoking treatments completed a battery of five ADS screening instruments and answered a single-item question about having ADS. Those with a positive self-report on the single-item question were also asked about their interference beliefs. The primary outcome was complete-case, self-reported 30-day point prevalence abstinence at 12 months.

Results

Both assessment approaches significantly predicted cessation. Screening positive for ≥ one ADS in the battery was associated with 23% lower odds of quitting than not screening positive for any (p = .023); those with a positive self-report on the single-item had 39% lower odds of quitting than self-reporting no mental health conditions (p < .001). Area under the receiver operating characteristic curve values for the two assessment approaches were similar (p = .136). Adding the interference belief question to the single-item assessment significantly increased the area under the receiver operating characteristic curve value (p = .042).

Conclusions

The single-item question assessing ADS had as much predictive validity, and possibly more, than the battery of screening instruments for identifying participants at risk for failing to quit smoking. Adding a question about interference beliefs significantly increased the predictive utility of the single-item question.

Implications

This is the first study to demonstrate that a single-item question assessing ADS has at least as much predictive validity, and possibly more, than a battery of validated screening instruments for identifying smokers at highest risk for cessation failure. This study also demonstrates adding a question about interference beliefs significantly adds to the predictive utility of a single, self-report question about mental health conditions. Findings from this study can be used to inform decisions regarding how to assess ADS in the context of tobacco treatment settings.
Art in Renaissance Siena
Authors: Nevola Fabrizio
Published: May 2020

While the first half of the 14th century, during the period in which Siena was ruled by the elected officials known as the “Nine” (1287–1355), has tended to be considered the city’s political, economic, and cultural heyday, scholarship over the past decades has reassessed the period following the demographic disaster inflicted by the Black Death (1348). Siena remained an independent city-state through much of the Renaissance period, losing its independence to the Imperial forces of Emperor Charles V (1555), who then ceded it briefly to his son Philip (later Philip II) and who, in turn, sold the city in 1557 to Duke Cosimo de’ Medici to form part of the Medici dominions. Sienese political life throughout the 15th century was marked by complex wrangling between rival factions, although the republican system prevailed—with an intermission during the ascendancy of the quasi-prince Pandolfo Petrucci (c. 1503–1512) and his heirs (to 1525)—until its loss of independence. As a result, a pattern of civic patronage remained at the fore, with major commissions funded by and directed toward the main civic institutions, including the city hall (Palazzo Pubblico), cathedral, and public hospital (Santa Maria della Scala) as well as public infrastructure, such as gates, walls, and water supply. Based, in part, on the continuities of government and its institutions from the 14th century into the Renaissance period, the art of Siena has tended to be characterized in the scholarly literature by elements of tradition and continuity. Until relatively recently, 15th-century painting was viewed quite simplistically as slavishly continuing in the vein of the earlier century, characterized by gold backgrounds and religious iconography derived from local civic devotion and a resistance to stylistic innovation. Nevertheless, a wave of new studies over the past fifteen years has led to a reappraisal of the city’s artistic production. These works have tended to view the distinctive style that characterized Sienese art as consciously defining a local identity through painting, sculpture, and architecture that was unique, and intentionally different, from that of its close neighbor and competitor, Florence. Although there is no comparison between the volume of research conducted on Siena and that on major Renaissance cities such as Rome, Florence, and Venice, Siena has certainly earned the status of a place worthy of consideration among the significant sites of artistic production. This article reveals that English-language research on Sienese art is far from systematic, and it is surprising that many major artists have received only limited attention.
Peace Education in Post-Conflict Zones
Authors: Kroeker Wendy
Published: May 2020

Peace education explores the factors that foster the abilities for individuals and communities to live together harmoniously. The field of peace education that examines post-conflict zones has rapidly expanded as an area of study intersecting both peace education and peacebuilding challenges. See the separate Oxford Bibliographies article in International Relations “Post-Conflict Peacebuilding.” Peace education, although challenging to define precisely, emerges as a particular field oriented toward enhancing knowledge, skills, and attitudes toward building understanding, tolerance, and environmental care along with a respect for human rights and freedoms. As such, it has contributed as an area of social importance given that it seeks to focus on the prevention of future conflict and the reduction of current conflicts. The expansion of the field has acknowledged the complexities of applying peace education principles in post-conflict contexts. This serves to enhance the ability to define the field. Many post-conflict peace educators link their work with the theories of conflict resolution and transformation. See the separate Oxford Bibliographies article in International Relations “Conflict Management.” The context in which the education takes place greatly impacts the type of approach taken. Consequently, this means that the “cookie cutter” approach is not able to effectively address the essential areas of need. Contextualized long- and short-term goals need to be considered as components for social change. Toward this effort, the use of localized knowledge is essential to ensure that a curriculum can contribute constructively to the sustainability of peace in a region. Utilizing local approaches supports the possibility of creating a culture of peace that responds to the existent needs and addresses the experiences of conflict and violence. The hoped-for result is the emergence of valuable skills applicable toward the goal of reconciliation. Considering the complexities within conflict-impacted communities, attention must be directed toward critical study of the issues and sensitivities required. In addition to highlighting the local and the potential benefits of intergroup encounters, this bibliography will also focus on the large frameworks of peace education leading to the emergence of post-conflict peace education as a distinct focus area of the education for peacebuilding field.
Native American Studies
Authors: Lee Tiffany , Lee Lloyd , Vicenti Carpio Myla
Published: May 2020

While Indigenous knowledge systems, theories, and research have been in existence for time immemorial, the academic field of Native American Studies (NAS) grew out of the civil rights era in the late 1960s. During the late 1960s and throughout the 1970s, Native people in the United States organized resistance efforts, such as the reclaiming of Alcatraz Island in 1969, the 1972 Trail of Broken Treaties march to Washington, DC, and the seventy-two-day protest and prayer at Wounded Knee in 1973. These activities are a few of the most well known, yet Native peoples have been resisting occupation of their lands, assimilationist forces, and settler colonialism and reclaiming land for decades. Activist groups such as the American Indian Movement organized many of these efforts, and with the increase of Native American students entering college during this time period, the level of activism and public awareness aligned with students’ demands for Native knowledge, perspectives, and experiences to be included in college courses. They also challenged universities to hire more Native American faculty. NAS in universities came out of these efforts, and academic programs were created from the West Coast to the East Coast in several universities. NAS draws on interdisciplinary perspectives from areas such as history, political science, anthropology, sociology, and education to examine the historical and modern issues faced by Native American and other Indigenous people and communities globally. This interdisciplinary approach allows scholars of NAS to examine the complexities and breadth of interests and problems in Native American communities. Of particular significance is the understanding and exercise of political sovereignty among Native Nations, which sets NAS apart from other ethnic-studies areas. Sovereignty is the right of a people to self-governance and self-determination. This includes rights to self-education and linguistic and cultural expression. Native Nations’ inherent sovereignty was recognized during treaty negotiations and agreements, and it has provided the basis for policies affecting Native communities today. This article recognizes the diverse areas of study that encompass NAS, including important areas connected to Native Nations’ application of their sovereign rights. The article identifies twelve subject areas that have prominence in scholarship that informs NAS. It also prioritizes scholarship by Indigenous authors, who provide the perspectives and lived experiences relevant to NAS.
Universal access to quality childcare is good policy and a positive determinant of health. Let’s invest.
Authors: Armstrong Shafeeq
Published: May 2020

Research shows that affordable nonprofit childcare results in a variety of beneficial developmental outcomes for children, as well as benefitting families and society at-large. As leaders and influencers, paediatricians are well positioned to advocate for access to affordable, nonprofit childcare. This commentary aims to provide a framework and evidence base for Canadian paediatricians interested in learning more about this issue and how they can support increased access to nonprofit childcare.
Peripheral Nerve Stimulation of the Brachial Plexus for Chronic Refractory CRPS Pain of the Upper Limb: Description of a New Technique and Case Series
Authors: Frederico Thiago Nouer , da Silva Freitas Tiago
Published: May 2020

Objective

Upper limb complex regional pain syndrome is an important cause of chronic pain, and its treatment is challenging. In this pilot case series, we preliminarily evaluated the feasibility, effectiveness, and safety of a new technique for brachial plexus neuromodulation in the treatment of this disease in patients refractory to conservative treatment.

Methods

Between 2017 and 2018, 14 patients considered to be refractory to optimized conservative treatment were recruited to this study. In the first stage, patients were trialed for seven days with a new technique of implant of the brachial plexus. Patients with ≥50% pain relief in visual analog scale (VAS) score received a definitive implantation in the second stage. Follow-ups were conducted at pre-implant and 12 months using the Neuropathic Pain Scale, SF-32, and the visual analogic scale for pain.

Results

After the initial trial, 10 patients had a pain reduction of ≥50% and received a permanent implant. At 12-month follow-up, VAS, Neuropathic Pain Scale, SF-12 physical and mental scores improved by 57.4% +/- 10% (P = 0.005), 60.2% +/- 12.9% (P = 0.006), and 21.9% +/- 5.9% (P = 0.015), respectively.

Conclusions

Our data suggest that this new technique of brachial plexus stimulation may have long-term utility in the treatment of painful upper limb complex regional pain syndrome. New more detailed comprehensive studies should be carried out to confirm our findings in a larger population and to further refine the clinical implementation of this technique.
Feasibility and Acceptability of an Abbreviated, Four-Week Mindfulness Program for Chronic Pain Management
Authors: Brintz Carrie E , Roth Isabel , Faurot Keturah , Rao Sanjana , Gaylord Susan A
Published: May 2020

Objective

The Mindfulness-Based Stress Reduction program is effective at improving chronic pain outcomes, but the time demand hinders participation. This preliminary study evaluated the feasibility, acceptability, and potential effects of providing an abbreviated mindfulness program for patients with chronic pain.

Design

A single-arm, mixed-methods, pre–post intervention study.

Setting

An outpatient rehabilitation clinic at an academic medical center.

Subjects

Participants were N = 23 adults with chronic pain who were new to mindfulness practice.

Methods

Mindfulness-based Stress Reduction was adapted to shorten the program to four weekly 90-minute sessions and to focus content on pain management. Three cohorts of six to nine participants completed baseline and post-treatment measures of 1) patient-reported outcomes, including pain intensity, pain interference, physical functioning, depressive/anxiety symptoms, positive affect and well-being, and sleep disturbance; 2) pain medication dosages; 3) psychosocial variables including pain acceptance, pain catastrophizing, and perceived stress; 4) dispositional mindfulness, as well as postintervention structured interviews about their experiences.

Results

Acceptable rates of retention and attendance and high ratings of satisfaction indicated that the intervention was feasible and acceptable. In interviews, participants found the program acceptable and beneficial and provided suggestions to improve it. From pre- to post-treatment, significant improvements were reported in all measures except physical functioning and anxiety.

Conclusions

In adults with chronic pain, a four-week mindfulness program is feasible and acceptable, addresses the barrier of a lengthy program, and may improve quality of life and psychological functioning. An appropriately powered randomized controlled trial with a comparison group is needed to assess the intervention’s effectiveness.
0002 Decreased Concentration of Klotho and Increased Concentration of FGF-23 in the Cerebrospinal Fluid of Patients with Narcolepsy
Authors: Oliveira G P , Elias R M , Fernandes G B , Moyses R , Tufik S , Bichuetti D B , Coelho F M
Published: May 2020

Introduction

Narcolepsy is a disorder characterized by hypersomnolence, cataplexy, sleep paralysis, hallucinations and sleep fragmentation. Patients with type 1 narcolepsy have cataplexy and/or hypocretin-1 deficiency. Klotho is a protein expressed by kidneys and choroid plexus, with anti-aging properties. Fibroblast growth factor 23 (FGF-23) is a hormone secreted by osteocytes with actions on mineral metabolism. The purpose of study was to explore the status of concentration of klotho and FGF23 in the cerebrospinal fluids (CSF) of patients with narcolepsy.

Methods

59 patients with narcolepsy and 17 individuals were enrolled. We used a radioimmunoassay technique, human klotho enzyme-linked immunosorbent assay (ELISA), human intact FGF23 ELISA and spectrophotometry to measure hypocretin-1, klotho, FGF-23 and phosphorus, respectively. T-Student Test was used to compare klotho and phosphate concentrations and Mann-Whitney U Test was used to compare FGF-23 levels between groups. ANOVA Test was used to compare klotho and phosphate CSF concentrations among narcolepsy patients with CSF hypocretin-1 <110pg/ml (HCRT-) and narcolepsy patients with CSF hypocretin-1 >110pg/ml (HCRT+) versus control subjects.

Results

Klotho and phosphorus CSF levels were lower in narcoleptic patients than in control (908.18 ± 405.51 versus 1265.78 ± 523.26 pg/ml; p=0.004 and 1.34 ± 0.25 versus 1.58 ± 0.23 mg/dl; p= 0.001, respectively). We found higher median FGF-23 levels in narcoleptic patients (5.51 versus 4.00 RU/ml; p= 0.001). Klotho and phosphorus CSF levels were lower in both HCRT-/HCRT+ than controls (892.63 ± 388.34/ 925.95 ± 430.76 versus 1265.78 ± 523.26 pg/ml; p=0.014 and 1.35 ± 0.28/ 1.33 ± 0.22 versus 1.58 ± 0.23 mg/dl; p= 0.004). Moreover, we found higher median FGF-23 levels in both HCRT-/HCRT+ groups versus controls (5.51/ 6.02 versus 4.00 RU/ml in controls), p= 0.009.

Conclusion

Patients with narcolepsy have decreased CSF concentration of klotho and increased CSF levels of FGF-23. These findings may play a role in understanding the pathogenesis of narcolepsy.

Support
0003 LGI1 and CASPR2 Autoimmunity: Sleep Symptoms, Polysomnography, and Quantitative REM Sleep without Atonia
Authors: Devine M F , Feemster J C , Lieske E A , McCarter S J , Sandness D J , Steele T , Boeve B F , Silber M H , McKeon A , St. Louis E K
Published: May 2020

Introduction

Sleep disturbances, including rapid eye movement (REM) behavior disorder (RBD), are known manifestations of voltage-gated-potassium-channel-complex VGKC-IgG seropositivity (VGKC+). Discovery of leucine-rich, glioma inactivated protein 1 (LGI1) and contactin-associated protein 2 (CASPR2) have refined our understanding of VGKC+. VGKC+ without LGI1/CASPR2-IgG (“double-negative”) has lost its clinical significance. Previous detailed sleep analysis of these subtypes has been limited.

Methods

We performed a retrospective study to characterize clinical and polysomnographic features of LGI1/CASPR2 seropositive (LGI1+/CASPR2+) and VGKC double-negative patients, including quantitative REM sleep without atonia (RSWA). Quantified RSWA was compared to matched controls and normative RSWA percentiles.

Results

Eleven LGI1+/CASPR2+ (LGI1+, 9) and twelve VGKC double-negative patients were analyzed. Insomnia was seen in 55% of LGI1+/CASPR2+ and 8% of VGKC double-negative patients (p=0.05). The LGI1+/CASPR2+ group had reduced slow wave sleep compared to the VGKC double-negative group. Five LGI1+ patients had clinical dream enactment behavior (DEB). Eight LGI1+ patients met quantitative diagnostic levels of RSWA. Higher RSWA levels were seen in the LGI1+/CASPR2+ group. Ten LGI1+/CASPR2+ patients received immunotherapy; all ten neurologically benefited with sleep benefits in 6/10.

Conclusion

Sleep disorders such as insomnia and RBD are part of the LGI1/CASPR2 autoimmune phenotype. Objective sleep manifestations can be seen on polysomnogram in the form of reduced N3 and elevated RSWA as compared to controls. Quantitative RSWA analysis identified RBD in more LGI1+ patients than clinical report or qualitative RSWA. In this study, RBD was only seen with LGI1+, not CASPR2+. The intermediate RSWA levels of the VGKC double-negative patients may suggest a spectrum of abnormal motor activity in these related antibodies. Additional studies are needed to further explore the biomarker potential of quantitative RSWA in autoimmune neurological conditions.

Support

This project was supported by the National Center forResearch Resources, National Institutes of Health, through Grant Number 1 UL1 RR024150- 01.
0004 TS-142: A Novel and Potent Dual Orexin Receptor Antagonist with Sleep-Promoting Effects in Rats
Authors: Kambe D , Hikichi H , Tokumaru Y , Ohmichi M , Konno Y , Hino N
Published: May 2020

Introduction

The orexin system plays a pivotal role in regulating sleep and wakefulness, thus, orexin receptors (OX1 and OX2 receptors) have gained much attention as promising therapeutic targets for the treatment of insomnia. We synthesized a novel and potent dual orexin receptor antagonist (DORA), ORN0829 (investigation code name as TS-142), which was designed to have short-acting effects. Here we report pharmacological and pharmacokinetic profiles of ORN0829 in rats.

Methods

The antagonistic activities of ORN0829 were assessed using calcium mobilization assays. Ala-orexin A-induced [Ca2+]i response was measured with CHO-K1 cells stably expressing human/rat orexin receptor. Rats implanted the EEG/EMG electrodes were orally administrated ORN0829 at doses of 1, 3 or 10 mg/kg at the dark onset and sleep-wake stages were inspected visually. In addition, pharmacokinetic profiles of ORN0829 were investigated in rats.

Results

ORN0829 inhibited Ala-orexin A-increased [Ca2+]i response with a Kb of 0.67/0.44 nmol/L (for human/rat OX1 receptor), and with a Kb of 0.84/0.80 nmol/L (for human/rat OX2 receptor), respectively, indicating that ORN0829 is a potent DORA with no species differences. ORN0829 dose-dependently increased total sleep time and reduced sleep onset latency at doses of 1, 3 and 10 mg/kg. Importantly, the ORN0829 levels in plasma and cerebrospinal fluid rapidly reached a maximum concentration, and decreased with an elimination half-life of less than 1 h.

Conclusion

The present study indicates that ORN0829 is a novel and potent DORA with sleep-promoting effects, and that it exhibits ideal pharmacokinetic profiles (rapid absorption and short half-life) in rats. A phase 2a study of TS-142 using patients with insomnia has been completed, which is presented in a separate poster.

Support

Taisho Pharmaceutical. Co., Ltd.