bluuebunny/crossref_metadata_2025 huggingface dataset:
I–Love–Q relations for realistic white dwarfs
Authors: Taylor Andrew J , Yagi Kent , Arras Phil L
Published: December 2019

The space-borne gravitational wave interferometer, Laser Interferometer Space Antenna, is expected to detect signals from numerous binary white dwarfs. At small orbital separation, rapid rotation and large tidal bulges may allow for the stellar internal structure to be probed through such observations. Finite-size effects are encoded in quantities like the moment of inertia (I), tidal Love number (Love), and quadrupole moment (Q). The universal relations among them (I–Love–Q relations) can be used to reduce the number of parameters in the gravitational-wave templates. We here study I–Love–Q relations for more realistic white dwarf models than used in previous studies. In particular, we extend previous works by including (i) differential rotation and (ii) internal temperature profiles taken from detailed stellar evolution calculations. We use the publicly available stellar evolution code mesa to generate cooling models of both low- and high-mass white dwarfs. We show that differential rotation causes the I–Q relation (and similarly the Love–Q relation) to deviate from that of constant rotation. We also find that the introduction of finite temperatures causes the white dwarf to move along the zero-temperature mass sequence of I–Q values, moving towards values that suggest a lower mass. We further find that after only a few Myr, high-mass white dwarfs are well described by the zero-temperature model, suggesting that the relations with zero temperature may be good enough in most practical cases. Low-mass, He-core white dwarfs with thick hydrogen envelopes may undergo long periods of H burning which sustain the stellar temperature and allow deviations from the I–Love–Q relations for longer times.
Probing black hole accretion tracks, scaling relations, and radiative efficiencies from stacked X-ray active galactic nuclei
Authors: Shankar Francesco , Weinberg David H , Marsden Christopher , Grylls Philip J , Bernardi Mariangela , Yang Guang , Moster Benjamin , Fu Hao , Carraro Rosamaria , Alexander David M , Allevato Viola , Ananna Tonima T , Bongiorno Angela , Calderone Giorgio , Civano Francesca , Daddi Emanuele , Delvecchio Ivan , Duras Federica , La Franca Fabio , Lapi Andrea , Lu Youjun , Menci Nicola , Mezcua Mar , Ricci Federica , Rodighiero Giulia , Sheth Ravi K , Suh Hyewon , Villforth Carolin , Zanisi Lorenzo
Published: December 2019

The masses of supermassive black holes at the centres of local galaxies appear to be tightly correlated with the mass and velocity dispersions of their galactic hosts. However, the local Mbh–Mstar relation inferred from dynamically measured inactive black holes is up to an order-of-magnitude higher than some estimates from active black holes, and recent work suggests that this discrepancy arises from selection bias on the sample of dynamical black hole mass measurements. In this work, we combine X-ray measurements of the mean black hole accretion luminosity as a function of stellar mass and redshift with empirical models of galaxy stellar mass growth, integrating over time to predict the evolving Mbh–Mstar relation. The implied relation is nearly independent of redshift, indicating that stellar and black hole masses grow, on average, at similar rates. Matching the de-biased local Mbh–Mstar relation requires a mean radiative efficiency ε ≳ 0.15, in line with theoretical expectations for accretion on to spinning black holes. However, matching the ‘raw’ observed relation for inactive black holes requires ε ∼ 0.02, far below theoretical expectations. This result provides independent evidence for selection bias in dynamically estimated black hole masses, a conclusion that is robust to uncertainties in bolometric corrections, obscured active black hole fractions, and kinetic accretion efficiency. For our fiducial assumptions, they favour moderate-to-rapid spins of typical supermassive black holes, to achieve ε ∼ 0.12–0.20. Our approach has similarities to the classic Soltan analysis, but by using galaxy-based data instead of integrated quantities we are able to focus on regimes where observational uncertainties are minimized.
Artificial Neural Networks to Assess Virtual Reality Anterior Cervical Discectomy Performance
Authors: Mirchi Nykan , Bissonnette Vincent , Ledwos Nicole , Winkler-Schwartz Alexander , Yilmaz Recai , Karlik Bekir , Del Maestro Rolando F
Published: December 2019

BACKGROUND

Virtual reality surgical simulators provide a safe environment for trainees to practice specific surgical scenarios and allow for self-guided learning. Artificial intelligence technology, including artificial neural networks, offers the potential to manipulate large datasets from simulators to gain insight into the importance of specific performance metrics during simulated operative tasks.

OBJECTIVE

To distinguish performance in a virtual reality-simulated anterior cervical discectomy scenario, uncover novel performance metrics, and gain insight into the relative importance of each metric using artificial neural networks.

METHODS

Twenty-one participants performed a simulated anterior cervical discectomy on the novel virtual reality Sim-Ortho simulator. Participants were divided into 3 groups, including 9 post-resident, 5 senior, and 7 junior participants. This study focused on the discectomy portion of the task. Data were recorded and manipulated to calculate metrics of performance for each participant. Neural networks were trained and tested and the relative importance of each metric was calculated.

RESULTS

A total of 369 metrics spanning 4 categories (safety, efficiency, motion, and cognition) were generated. An artificial neural network was trained on 16 selected metrics and tested, achieving a training accuracy of 100% and a testing accuracy of 83.3%. Network analysis identified safety metrics, including the number of contacts on spinal dura, as highly important.

CONCLUSION

Artificial neural networks classified 3 groups of participants based on expertise allowing insight into the relative importance of specific metrics of performance. This novel methodology aids in the understanding of which components of surgical performance predominantly contribute to expertise.
Gender Politics and Legislative Networks in Taiwan: An Analysis of Women-Bill Co-Sponsorship and Bill Success
Authors: Shim Jaemin
Published: December 2019

This article examines how legislative networks can be utilised to further the interests of female voters. Specifically, I investigate how legislators’ gender and partisanship within co-sponsorship networks are related to the successful passage of women bills. For this goal, the article focusses on Taiwan—where both women’s descriptive and substantive representations have improved dramatically since democratisation and, at the same time, co-sponsoring bills have been a legislative process of the ongoing significance. The article utilises an original bill co-sponsorship dataset that consists of 232,734 co-sponsors related to all bills submitted between 2005 and 2016. By comparing women and non-women bills, the article demonstrates that the legislative effectiveness on women bills varied by legislator’s gender and affiliated party. That is, the proportion of male legislators in the co-sponsorship network did not effect on women bill success, while it turned out to be positively related to non-women bill success. Moreover, the proportion of right-leaning party legislators in the co-sponsorship network decreased the odds of women bill passage while increasing the chance of non-women bill ones. Despite the increasing participation of male legislators and right-leaning party legislators in co-sponsoring women’s issues in Taiwan, the results demonstrate that their role was limited on the success of women bills.
Weak scale from Planck scale: Mass scale generation in a classically conformal two-scalar system
Authors: Haruna Junichi , Kawai Hikaru
Published: December 2019

In the standard model, the weak scale is the only parameter with mass dimensions. This means that the standard model itself cannot explain the origin of the weak scale. On the other hand, from the results of recent accelerator experiments, except for some small corrections, the standard model has increased the possibility of being an effective theory up to the Planck scale. From these facts, it is naturally inferred that the weak scale is determined by some dynamics from the Planck scale. In order to answer this question, we rely on the multiple point criticality principle as a clue and consider the classically conformal $\mathbb{Z}_2\times \mathbb{Z}_2$ invariant two-scalar model as a minimal model in which the weak scale is generated dynamically from the Planck scale. This model contains only two real scalar fields and does not contain any fermions or gauge fields. In this model, due to a Coleman–Weinberg-like mechanism, the one-scalar field spontaneously breaks the $ \mathbb{Z}_2$ symmetry with a vacuum expectation value connected with the cutoff momentum. We investigate this using the one-loop effective potential, renormalization group and large-$N$ limit. We also investigate whether it is possible to reproduce the mass term and vacuum expectation value of the Higgs field by coupling this model with the standard model in the Higgs portal framework. In this case, the one-scalar field that does not break $\mathbb{Z}_2$ can be a candidate for dark matter and have a mass of about several TeV in appropriate parameters. On the other hand, the other scalar field breaks $\mathbb{Z}_2$ and has a mass of several tens of GeV. These results will be verifiable in near-future experiments.
Eugen Bleuler’s Views on the Genetics of Schizophrenia in 1917
Authors: Kendler Kenneth S
Published: December 2019

In 1917, Eugen Bleuler published an article (Mendelismus bei Psychosen, speziell bei der Schizophrenie [Mendelism in the Psychoses, especially Schizophrenia]) in response to the recently published first systematic family study of dementia praecox (DP) by Ernst Rüdin, then working under Kraepelin in Munich. Although briefly commented upon by David Rosenthal in 1978, this article has never been thoroughly reviewed or translated. Of the many themes addressed, four are especially noteworthy. First, Bleuler argues that understanding the transmission patterns of schizophrenia in families requires definitive knowledge about the boundaries of the phenotype which he argues are unknown. Rüdin’s choice—Kraepelin’s concept of DP—is, he asserts, too narrow. Clarifying the genetics of schizophrenia is inextricably bound up with the problem of defining the phenotype. Second, Bleuler argues for the importance of “erbschizose” (literally “inherited schizoidia”) wondering whether his “4 As” or other “brain-anatomical, chemical, [or] neurological characteristics” might underlie the genetic transmission of schizophrenia. Third, Bleuler was deeply interested in the nature of the onset of schizophrenia, suggesting that environmental adversity could provoke “latent illness to become manifest.” It was important, he argued, to identify such risk factors and incorporate them into genetic models. Fourth, although not optimistic that current knowledge would permit a resolution of the transmission model for schizophrenia, he finds single-locus models implausible and at several points wonders whether polygenic models might better apply. A complete translation of the article is provided.
GABA and glycine neurons from the ventral medullary region inhibit hypoglossal motoneurons
Authors: Dergacheva Olga , Fleury-Curado Thomaz , Polotsky Vsevolod Y , Kay Matthew , Jain Vivek , Mendelowitz David
Published: December 2019

Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive sleep-related losses of upper airway patency that occur most frequently during rapid eye movement (REM) sleep. Hypoglossal motoneurons play a key role in regulating upper airway muscle tone and patency during sleep. REM sleep activates GABA and glycine neurons in the ventral medulla (VM) to induce cortical desynchronization and skeletal muscle atonia during REM sleep; however, the role of this brain region in modulating hypoglossal motor activity is unknown. We combined optogenetic and chemogenetic approaches with in-vitro and in-vivo electrophysiology, respectfully, in GAD2-Cre mice of both sexes to test the hypothesis that VM GABA/glycine neurons control the activity of hypoglossal motoneurons and tongue muscles. Here, we show that there is a pathway originating from GABA/glycine neurons in the VM that monosynaptically inhibits brainstem hypoglossal motoneurons innervating both tongue protruder genioglossus (GMNs) and retractor (RMNs) muscles. Optogenetic activation of ChR2-expressing fibers induced a greater postsynaptic inhibition in RMNs than in GMNs. In-vivo chemogenetic activation of VM GABA/glycine neurons produced an inhibitory effect on tongue electromyographic (EMG) activity, decreasing both the amplitude and duration of inspiratory-related EMG bursts without any change in respiratory rate. These results indicate that activation of GABA/glycine neurons from the VM inhibits tongue muscles via a direct pathway to both GMNs and RMNs. This inhibition may play a role in REM sleep associated upper airway obstructions that occur in patients with OSA.
Assessing Deprivation with an Ordinal Variable: Theory and Application to Sanitation Deprivation in Bangladesh
Authors: Seth Suman , Yalonetzky Gaston
Published: December 2019

The challenges associated with poverty measurement using a cardinal variable have received much attention over the past four decades, but there is a dearth of literature on how to meaningfully assess poverty with an ordinal variable. This article proposes a class of simple, intuitive, and policy-relevant poverty measures for ordinal variables. The measures are sensitive to the depth of deprivations, unlike the headcount ratio. Moreover, under appropriate restrictions, the measures ensure that priority is given to the poorest among the poor when targeting, monitoring, and evaluating poverty alleviation programs. To assess the robustness of poverty comparisons to alternative choices of parameters, the article develops various stochastic dominance tests (some of which are novel contributions to the stochastic dominance literature). The empirical illustration documenting changes in sanitation deprivation in Bangladesh showcases the measures’ ability to identify instances in which overall sanitation deprivation improved while leaving the poorest behind.
Diagnostic approach to occupational rhinitis: the role of nasal provocation tests
Authors: Ronsmans Steven , Steelant Brecht , Backaert Wout , Nemery Benoit , Van Gerven Laura
Published: December 2019

Purpose of review

The diagnosis of occupational rhinitis is a challenge. Underdiagnosis is substantial as the clinical presentation is nonspecific and often no occupational history is taken. Detection of occupational rhinitis can be improved by including screening questions on occupational exposure in the assessment of every patient with adult-onset rhinitis.

Recent findings

Case reports, case series and epidemiological studies continuously demonstrate new sensitizers and irritants capable of inducing allergic or nonallergic (irritant-induced) occupational rhinitis. Recent reviews have focused on the value of immunological tests with specific IgE, skin prick tests or basophil activation tests in demonstrating sensitization to occupational agents. Nasal provocation tests (NPT) can establish a definite diagnosis of allergic occupational rhinitis. Several NPT guidelines have been published, however, focusing exclusively on standardized high-molecular weight allergens. When performing NPT with nonstandardized agents -- like most occupational sensitizers -- adapted protocols are needed.

We provide pragmatic guidance to clinicians taking care of rhinitis patients on how to diagnose occupational rhinitis, based on recent insights from the literature. We focus on the challenges in the diagnostic work-up, on how to identify suspected causes, and on the role of NPT.
Mechanisms of resistance and predictive biomarkers of response to targeted therapies and immunotherapies in metastatic melanoma
Authors: Mourah Samia , Louveau Baptiste , Dumaz Nicolas
Published: December 2019

Purpose of review

Thanks to mitogen-activated protein kinase inhibitors (MAPKi) and immune checkpoint inhibitors (ICI), major progress has been made in the field of melanoma treatment. However, long-term success is still scarce because of the development of resistance. Understanding these mechanisms of resistance and identifying predictive genomic biomarkers are now key points in the therapeutic management of melanoma patients.

Recent findings

Multiple and complex mechanisms of resistance to MAPKi or ICI have been uncovered in the past few years. The lack of response can be driven by mutations and nonmutational events in tumor cells, as well as by changes in the tumor microenvironment. Melanoma cells are also capable of rapidly switching their molecular and cellular phenotype, leading to an initial drug-tolerant favorizing melanoma resistance. Tumor molecular profiling and circulating tumor cell analyses are of high interest as predictive biomarkers as well as studying immunogenic changes and microbiome in ICI-treated patients.

Resistance to MAPKi and ICI is a key point in therapeutic management of metastatic melanoma patients. Validated biomarkers predicting response to therapy are urgently needed to move toward personalized medicine. Combinatory treatments guided by the understanding of resistance mechanisms will be of major importance in the future of melanoma therapy.
Analysis of Speaking Opportunities by Gender at National Dermatologic Surgery Conferences
Authors: Flaten Hania K. , Goodman Lillian , Wong Emily , Hammes Andrew , Brown Mariah R.
Published: December 2019

BACKGROUND

Although gender disparities for those entering medicine have equalized, the number of women advancing in academia has remained low. Studies have demonstrated that women's representation at academic medical conferences has also remained low across multiple fields. Given that conference presentations and national reputation serve as metrics for academic promotion, women's representation at dermatology conferences may provide insight into women's academic productivity.

OBJECTIVE

To examine the gender composition of presenters and speaking time at the 2 main national dermatologic surgery conferences.

METHODS

Speaker's gender, presentation time, and topics were collected for 2009 to 2017 for the American College of Mohs Surgery (ACMS) and the American Society for Dermatologic Surgery (ASDS) Annual Meetings.

RESULTS

Women had significantly fewer speaking opportunities and speaking minutes at both conferences. This disparity was most pronounced in reconstruction topics and least pronounced in cosmetics topics. The majority of top speakers, repeat speakers, and keynote speakers were men for both conferences. Oral abstracts showed no gender disparity at either conference.

CONCLUSION

Women spoke less than men at both the ASDS and ACMS annual meetings over multiple years studied. Recently, this disparity in speaking opportunities has decreased. Further studies are needed to evaluate the speaking opportunities for women at other types of dermatology conferences.
Contribution of socioeconomic and environmental factors to geographic disparities in breast cancer risk in the Nurses’ Health Study II
Authors: Vieira Verónica M. , VoPham Trang , Bertrand Kimberly A. , James Peter , DuPré Natalie , Tamimi Rulla M. , Laden Francine , Hart Jaime E.
Published: December 2019

Background:

Evidence of geographic disparities in breast cancer incidence within the United States and spatial analyses can provide insight into the potential contribution of environmental exposures or other geographically varying factors to these disparities.

Methods:

We applied generalized additive models to smooth geocoded residential coordinates while adjusting for covariates. Our analysis included 3,478 breast cancer cases among 24,519 control women from the Nurses’ Health Study II. We first examined associations with residential location during adolescence (high school address) or early adulthood (address in 1991). We then assessed the contribution from known individual-level risk factors, measures of socioeconomic status, and occupational and environmental factors that vary spatially and have been linked to breast cancer. Secondary analyses by estrogen receptor and menopausal status were also conducted.

Results:

We identified geographic patterns of breast cancer risk associated with location during adolescence, with increased risk apparent in Michigan, the Northwest, and the New York City area, that shifted to southern New England when addresses during early adulthood were analyzed. Similar results were observed after adjustment for individual- and area-level factors, although spatial associations were no longer statistically significant.

Conclusions:

Breast cancer risk is not spatially uniform across the United States, and incidence patterns varied depending on the timing during life of the residence considered. Geographic disparities persisted even after accounting for established and suspected breast cancer risk factors, suggesting that unmeasured environmental or lifestyle risk factors may explain geographic variation in risk in different parts of the country.
Treatment of Acquired Digital Arteriovenous Malformation with Progression during Pregnancy
Authors: Fujimaki Hiroshi , Takeuchi Masaki
Published: December 2019

Acquired digital arteriovenous malformation (AVM) is a relatively rare form of AVM that occurs in the fingers. Together with a review of the literature, we report a rare case of acquired digital AVM that enlarged after pregnancy. The patient was a 32-year-old woman with the chief complaint of digital swelling accompanied by a burning sensation. During her pregnancy, the swelling of the fingers recurred, with a symptom of throbbing sensation. After giving birth, the swelling reduced but did not completely disappear. At the first visit, we observed purple discoloration and swelling of the ulnar aspect of the proximal interphalangeal joints of the left hand. Contrast-enhanced computed tomography scanning via the digital arteries of the left hand revealed a lesion showing early venous return, leading to the diagnosis of AVM. Surgery was performed under general anesthesia. The digital artery supplying the lesion was identified and dissected under a surgical microscope. At 15 months after surgery, there was no recurrence, sensory dysfunction, or mobility impairment.
Medication adherence in hypertension
Authors: Poulter Neil R. , Borghi Claudio , Parati Gianfranco , Pathak Atul , Toli Diana , Williams Bryan , Schmieder Roland E.
Published: December 2019

Suboptimal adherence to antihypertensive medication is a major contributor to poor blood pressure control. Several methods, direct or indirect, are available for measuring adherence, including the recently developed biochemical screening, although there is no gold-standard method routinely used in clinical practice to accurately assess the different facets of adherence. Adherence to treatment is a complex phenomenon and several of the barriers to adherence will need to be addressed at the healthcare system level; however, when looking at adherence from a more practical side and from the practitioner's perspective, the patient–practitioner relationship is a key element both in detecting adherence and in attempting to choose interventions tailored to the patient's profile. The use of single-pill combinations enabling simplification of treatment regimen, the implementation of a collaborative team-based approach and the development of electronic health tools also hold promise for improving adherence, and thus impacting cardiovascular outcomes and healthcare costs.
Subclinical left ventricular systolic dysfunction by two-dimensional speckle-tracking echocardiography and its relation to ambulatory arterial stiffness index in hypertensive patients
Authors: Ahmed Tarek A.N. , Shams-Eddin Hamdy , Fathy Marwa A. , El-Naggar Heba M. , Kishk Yehia T.
Published: December 2019

Background:

Increased arterial stiffness is associated with cardiovascular morbidity and mortality among hypertensive patients.

Objectives:

To assess the relationship between ambulatory arterial stiffness index (AASI) and subclinical left ventricular (LV) systolic dysfunction assessed by 2-D speckle-tracking echocardiography (STE).

Methods:

We enrolled 70 consecutive patients with hypertension. All patients were evaluated for parameters of ambulatory blood pressure monitoring (ABPM) including AASI. From those patients, 51 underwent conventional echocardiography as well as 2-D STE to assess for subclinical LV systolic dysfunction defined by global longitudinal strain (GLS) and global circumferential strain (GCS).

Results:

The mean age of the patients (n = 51) was 46.3 ± 12.3 years, women represented 59%. Study population were divided into two groups according to blood pressure control as defined by ABPM; controlled (n = 23), and uncontrolled (n = 28). Baseline characteristics were comparable between both groups. There were significant differences in both daytime and night-time mean ABPM (P < 0.05). Posterior wall thickness, as well as LV relative wall thickness were significantly higher in uncontrolled patients (P < 0.05 for each). AASI was significantly, but moderately correlated to GLS. Most ABPM parameters were elevated with the higher AASI values (AASI ≥0.5). Significantly more uncontrolled hypertensive patients were encountered as well. Interestingly, sex and AASI were predictors of impaired GLS by univariate linear regression analysis; however, AASI was the only independent predictor of impaired GLS on multivariate analysis (Beta = 0.3, CI = 0.2--12, and P = 0.04).

Conclusion:

AASI might predict subclinical LV systolic dysfunction as assessed by global longitudinal strain. Further wide-scale studies should further explore this intriguing hypothesis.
Anatomical relationships between medullary veins and three types of deep-seated malignant brain tumors as detected by susceptibility-weighted imaging
Authors: Yang Shih-Hung , Hong Chien-Tai , Tsai Fong Y. , Chen Wei-Yu , Chen Chia-Yuen , Chan Wing P.
Published: December 2019

Background:

Deep-seated brain tumors can be difficult to differentiate. Three tumor types (primary central nervous system lymphoma [PCNSL], high-grade glioma, and metastatic brain tumors), identified by susceptibility-weighted imaging, have different relationships with small medullary veins, and these relationships can be used to enhance diagnostic accuracy.

Methods:

Records of patients with pathology confirmed malignant brain tumors who received susceptibility-weighted imaging between 2009 and 2015 were reviewed. A total of 29 patients with deep-seated malignant brain tumors in the territory of small medullary veins were enrolled in this study. The sensitivity, specificity, and diagnostic accuracy of medullary vein blockage (MVB), defined as a small medullary vein terminating at the margin of the tumor, for indicating malignant brain tumors were analyzed.

Results:

Of 11 patients with PCNSLs, 5 with high-grade gliomas, and 13 with metastases, only the latter presented MVBs. The sensitivity, specificity, and accuracy of using MVBs for diagnosing metastatic tumors were 76.9%, 100%, and 89.7%, respectively.

Conclusion:

An MVB is an accurate sign for differentiating metastatic brain tumors from two other common malignancies and thus provides a useful tool for preoperative planning.
Effects of a Transdiagnostic Preventive Intervention on Anxiety and Depression Among Workers in Japan
Authors: Hidaka Yui , Imamura Kotaro , Sekiya Yuki , Watanabe Kazuhiro , Kawakami Norito
Published: December 2019

Objective:

This study examined the effectiveness of a newly developed transdiagnostic preventive intervention for anxiety and depressive symptoms among workers in a pre- and posttest study design.

Methods:

Participants were recruited from six companies and one medical clinic. The program was developed based on Unified Protocol. The outcomes were anxiety symptoms (GAD7), depressive symptoms (BDI-II), and psychological distress (K6), measured at baseline, 3-week, and 6-week follow-up. A mixed model for repeated measures was conducted for the whole sample and for a subgroup with higher psychological distress.

Results:

Among 75 participants, this program showed no significant effects on improving any outcome in the whole sample, but a significant improvement of psychological distress among the high-distress subgroup.

Conclusions:

The program may be effective in improving psychological distress among those who have high symptom levels.
Identifying Strategies for Decreasing Work-Related Stress Among Working Men
Authors: Eccles Heidi , Nannarone Molly , Smail-Crevier Rachel , Lashewicz Bonnie , Aiken Alice , Attridge Mark , Marchand Alain , Friesen Jordan , Wang JianLi
Published: December 2019

Objective:

The objective was to identify helpful, feasible strategies that can be implemented by working men to decrease work-related stress.

Methods:

An international Delphi consensus study was conducted with four panels of stakeholders. Three rounds of surveys were sent to panellists who rated the helpfulness and feasibility of strategies. Strategies were considered to have reached consensus if 80+% of at least three panels “agreed” or “strongly agreed” that the strategies were helpful or feasible.

Results:

Eighty-one strategies reached consensus out of a total 127 for helpfulness in decreasing work-related stress. Eleven strategies did not reach consensus in any of the vignettes. Only two strategies reached consensus for feasibility.

Conclusion:

While many strategies are perceived as helpful for decreasing workplace stress, the feasibility of the strategies likely depends on an individual's particular needs and context.
Drug-eluting balloons versus drug-eluting stents for small vessel coronary artery disease: a meta-analysis
Authors: Song Cai-xia , Zhou Chao , Hou Wenbo , Yin Yuxia , Lu Shoutao , Liu Guang , Duan Cuihai , Li Maoquan , Zhang Haijun
Published: December 2019

Objective

We aimed to conduct a network meta-analysis of treatments for small vessels coronary artery disease between drug-eluting balloon (DEB) and drug-eluting stent (DES).

Method

A meta-analysis comparing DEB and DES outcomes was performed using the Medline, Embase, and Cochrane databases. The primary outcome was target lesion revascularization (TLR) or target vessel revascularization (TVR), and myocardial infarction (MI), death and major adverse cardiovascular events (MACE) were secondary outcomes. A total of six studies on 1813 patients were included.

Results

There was no significant difference in rates of TLR or TVR in the patients treated with the DEB strategy compares with the DES strategy [odds ratio (OR) = 0.96, 95% confidence interval (CI) 0.57–1.61, P = 0.89] within a follow-up period of 9–24 months. There was a significant reduction in rates of MI and death in the patients treated with a DCB strategy compared with those treated with a DES strategy (3.7%, 17 of 460 vs 6.1%, 36 of 595; 2.4%, 11 of 460 vs 6.1%, 36 of 595, respectively), and this difference was statistically significant (OR = 0.53, 95% CI 0.29–0.96, P = 0.04; OR = 0.44, 95% CI 0.22–0.88, P = 0.02, respectively). There was no difference between DEB and DES strategies in rates of MACE (OR = 0.94, 95% CI 0.66–1.33, P = 0.73).

Conclusion

In summary, this study demonstrates that treatment of small vessel (diameter ≤ 3 mm) coronary artery disease (CAD) with DEB may lead to improving outcomes compared with the use of DES within a follow-up period of 9–24 months. Further large clinical trials are needed to verify this conclusion.
Positron emission tomography/magnetic resonance imaging for the diagnosis and differentiation of pancreatic tumors
Authors: Haodan Dang , Ruimin Wang , Jiajin Liu , Mu Lin , Xiang Feng , Baixuan Xu
Published: December 2019

Objective

This retrospective study aimed to evaluate the diagnostic efficiency of simultaneous positron emission tomography/magnetic resonance imaging (PET/MR) in differentiating the benign and malignant of pancreatic tumors as well as the differentiation of pancreatic cancer.

Methods

A total of 62 patients with suspected pancreatic tumors, diagnosed by PET/MR examinations, were collected in this study. These patients were divided into benign group and malignant group. The characteristics of the morphological MR, apparent diffusion coefficient (ADC), the mean of standardized uptake value (SUVmean), maximum values of standardized uptake value (SUVmax), in lesions were measured, and the novel parameters SUVpeak/ADC and SUVmax/ADC were constructed. The diagnostic efficiency for differentiating the benign and malignant lesions was analyzed by receiver operating characteristic (ROC) curve, and the diagnosis efficiency for the differentiation of pancreatic cancer was analyzed by Spearman correlation analysis.

Results

In differentiating the benign and malignant of pancreatic tumors, the diagnostic efficiency increased in the order of SUVpeak (AUROC: 0.760), SUVmax (AUROC: 0.774), T1T2 (AUROC: 0.789), ADC (AUROC: 0.817), SUVpeak/ADC (AUROC: 0.836), SUVmax/ADC (AUROC: 0.847). There was no significant correlation for SUVmax, SUVpeak, ADC, SUVpeak/ADC, and SUVmax/ADC with the differentiation of pancreatic cancer (P > 0.05). Besides, T1T2 was not significantly correlated to the differentiation of pancreatic cancer (P = 0.026, r = −0.406).

Conclusion

The integration of PET/MR imaging could be used to efficiently diagnose whether the pancreatic tumor was benign or malignant. The SUVmax/ADC was the most efficient metric, while it could not help in the differentiation of pancreatic cancer.
The cannabidiol conundrum: potential benefits and risks of cannabidiol products for children
Authors: Singer Lauren , Tokish Hannah , Park Faith , Campisi Christine , Milanaik Ruth L.
Published: December 2019

Purpose of review

Since the federal ban on hemp products was lifted in December 2018, cannabidiol (CBD), a nonpsychoactive cannabinoid derived from hemp, has become increasingly popular and accessible. CBD is sold in the form of oils, tablets, and foods in locations including gas stations, cafés, and drug stores. Despite a lack of reliable evidence, many parents praise its purported therapeutic effects on a variety of childhood ailments.

Recent findings

Epidiolex was the first CBD-based medication to be approved by the US Food and Drug Administration in 2018 for the treatment of two rare and severe forms of epilepsy, known as Lennox–Gastaut and Dravet syndrome, in patients of at least 2 years of age. Its efficacy was assessed through three randomized, double blind, and placebo-controlled trials in a sample of 516 patients with either Lennox–Gastaut syndrome or Dravet syndrome. Despite this development, there are few or no large-scale, rigorous studies concerning the effects of CBD on any other pediatric conditions that parents have tried to alleviate with CBD. The purpose of this review is to explore recent literature regarding the efficacy and safety of CBD in treating various health conditions in children; the risks of consuming CBD products, and the role of pediatricians in helping parents navigate often-confusing information about CBD.

Although CBD use has dramatically increased in recent years, both its potential to treat conditions and its risks have not yet been subjected to rigorous study. Pediatricians should be aware of the risks posed by poor-quality standards and labeling practices for cannabinoid products. Due to the confusing nature of the numerous sources of information about CBD, pediatricians are in a position to provide and clarify information about CBD to parents and understand the risks it poses to children.
Changes in liver allocation in United States
Authors: Leventhal Thomas M. , Florek Ellen , Chinnakotla Srinath
Published: December 2019

Purpose of review

United States has seen several significant changes in liver allocation. The aim of this review is to focus on those changes.

Recent findings

The success of liver transplantation led to its wider applicability for patients with end-stage liver disease. This success meant ultimately more patients were in need of transplantation, however, there was a limited availability of cadaveric organs. A system of prioritization was critical to reconcile the disparity between supply and demand of organs for liver transplantation. Liver allocation system has continuously evolved since inception. Implementation of the Model for End-Stage Liver Disease (MELD)-system of allocation occurred in 2002. Since then several ‘tweaks’ have been made to the allocation system. Most recently, United Network for Organ Sharing made significant changes to the liver-allocation policy to promote a broader sharing of livers. This policy eliminates the use of donor service areas (DSAs) and regions, and is consistent with direction given by the US Department of Health and Human Services Final Rule. This policy is awaiting implementation.

An ideal allocation policy would be fair, equitable and significantly reduce the waitlist mortality while simultaneously improving post transplantation outcomes. The impact of the recent changes in liver allocation on landscape of liver transplantation in United States is eagerly awaited.
Linking 24-h urines to clinical phenotypes: what alternatives does the future bring?
Authors: Sui Wilson , Hsi Ryan S.
Published: December 2019

Purpose of review

The 24-h urine test is recommended as part of the metabolic evaluation for patients with nephrolithiasis to guide preventive interventions. However, this test may be challenging to interpret and has limits in its predictive ability. In this review, we summarize and discuss the most recent research on the opportunities and challenges for utilizing urinary biomarkers for kidney stone prevention.

Recent findings

Contemporary studies utilizing the 24-h urine test have improved our understanding of how to better administer testing and interpret test results. Beyond the standard panel of 24-h urine parameters, recent applications of proteomics and metabolomics have identified protein and metabolic profiles of stone formers. These profiles can be assayed in future studies as potential biomarkers for risk stratification and prediction. Broad collaborative efforts to create large datasets and biobanks from kidney stone formers will be invaluable for kidney stone research.

Recent advances in our understanding of kidney stone risk have opened opportunities to improve metabolic testing for kidney stone formers. These strategies do not appear to be mutually exclusive of 24-h urine testing but instead complementary in their approach. Finally, large clinical datasets hold promise to be leveraged to identify new avenues for stone prevention.
Monitoring Eosinophilic Esophagitis Disease Activity With Blood Eosinophil Progenitor Levels
Authors: Henderson Anna , Magier Adam , Schwartz Justin T. , Martin Lisa J. , Collins Margaret H. , Putnam Philip E. , Mukkada Vincent A. , Abonia J. Pablo , Rothenberg Marc E. , Fulkerson Patricia C.
Published: December 2019

Objectives:

A minimally invasive biomarker to monitor disease activity is one of the greatest unmet clinical needs of the pediatric eosinophilic esophagitis (EoE) population. We aimed to determine whether circulating eosinophil progenitors (EoPs) could be used as a biomarker to identify pediatric patients with active EoE.

Methods:

In a prospective observational study, peripheral blood samples, symptom history, and laboratory data were collected from pediatric patients undergoing endoscopy for evaluation of EoE on dietary therapy at Cincinnati Children's Hospital. Peripheral blood EoP level was determined by flow cytometry.

Results:

Thirty‐four children with active (n = 16) and inactive (n = 18) EoE were included in the analysis. EoP levels in the peripheral blood were 3‐fold higher in patients with active EoE than inactive EoE (P < 0.0025). Blood absolute eosinophil count did not distinguish between active and inactive EoE (P = 0.16). A cut‐off EoP level ≥17 accurately detected active disease in 79% of patients with 94.4% specificity and 62.5% sensitivity (area under the curve 0.81; P < 0.0024). Antihistamine use lowered the threshold EoP level to detect active EoE.

Conclusions:

This study suggests that blood EoP levels may be used as a biomarker to detect active EoE disease in patients undergoing food trials and potentially reduce the need for repeated endoscopies. Larger prospective studies are needed to investigate the effects of antihistamines and swallowed steroids on EoP mobilization into the peripheral blood and longitudinal studies to assess the performance of the assay in individual patients over time.
Trauma in Youth At-Risk for Serious Mental Illness
Authors: Stowkowy Jacqueline , Goldstein Benjamin I. , MacQueen Glenda , Wang JianLi , Kennedy Sidney H. , Bray Signe , Lebel Catherine , Addington Jean
Published: December 2019

Childhood trauma has been shown to have detrimental consequences on mental health. It is unknown what impact childhood trauma may have on the early trajectory of serious mental illness (SMI). The purpose of this article is to estimate the baseline prevalence, perceived impact, and duration of trauma that occurred before the age of 18 years in youth at risk for SMI using a transdiagnostic approach. This study included 243 youths, ages 12 to 25 years (42 healthy controls, 43 non–help-seeking individuals [stage 0], 52 help-seeking youth experiencing distress and possibly mild symptoms of anxiety or depression [stage1a], and 108 youth demonstrating attenuated symptoms of an SMI such as bipolar disorder or psychosis [stage 1b]). Participants completed an adapted version of the Childhood Trauma and Abuse scale. There were high frequencies of reported trauma across all stages. Symptomatic individuals experienced more trauma and bullying. Stage 1b individuals reported more physical abuse. Stage 1b also indicated psychological bullying to have a longer duration and impact on their lives. Future work should aim to clarify the complex interrelations between trauma and risk of SMI.
Factors Associated With High Use of Hospital Psychiatric Services in Málaga, Spain
Authors: Guzmán-Parra José , Bordallo-Aragón Antonio , Moreno-Küstner Berta , Mayoral-Cleries Fermin
Published: December 2019

The early prediction of patients at risk may facilitate the efficient use of interventions that have been demonstrated to reduce readmissions. The aim of the study was to analyze variables during first admissions associated with further high use of an inpatient hospitalization psychiatric unit in Málaga, Spain. The risk of having three or more psychiatric admissions was analyzed in a sample of 1535 first-time admissions with multivariate Cox regression. In the multivariate model, the variables associated with the risk of high use were age at admission (p < 0.001), length of stay (p < 0.001), place of residence (p < 0.001), and previous history with mental health services (p < 0.001). The results suggest that there are several easily accessible characteristics at first admission that are potentially useful in detecting patients at risk.
The Potential Population-Level Impact of Different Gonorrhea Screening Strategies in Baltimore and San Francisco: An Exploratory Mathematical Modeling Analysis
Authors: Rönn Minttu M. , Testa Christian , Tuite Ashleigh R. , Chesson Harrell W. , Gift Thomas L. , Schumacher Christina , Williford Sarah L. , Zhu Lin , Bellerose Meghan , Earnest Rebecca , Malyuta Yelena , Hsu Katherine K. , Salomon Joshua A. , Menzies Nicolas A.
Published: December 2019

Background

Baltimore and San Francisco represent high burden areas for gonorrhea in the United States. We explored different gonorrhea screening strategies and their comparative impact in the 2 cities.

Methods

We used a compartmental transmission model of gonorrhea stratified by sex, sexual orientation, age, and race/ethnicity, calibrated to city-level surveillance data for 2010 to 2017. We analyzed the benefits of 5-year interventions which improved retention in care cascade or increased screening from current levels. We also examined a 1-year outreach screening intervention of high-activity populations.

Results

In Baltimore, annual screening of population aged 15 to 24 years was the most efficient of the 5-year interventions with 17.9 additional screening tests (95% credible interval [CrI], 11.8–31.4) needed per infection averted while twice annual screening of the same population averted the most infections (5.4%; 95% CrI, 3.1–8.2%) overall with 25.3 (95% CrI, 19.4–33.4) tests per infection averted. In San Francisco, quarter-annual screening of all men who have sex with men was the most efficient with 16.2 additional (95% CrI, 12.5–44.5) tests needed per infection averted, and it also averted the most infections (10.8%; 95% CrI, 1.2–17.8%). Interventions that reduce loss to follow-up after diagnosis improved outcomes. Depending on the ability of a short-term outreach screening to screen populations at higher acquisition risk, such interventions can offer efficient ways to expand screening coverage.

Conclusions

Data on gonorrhea prevalence distribution and time trends locally would improve the analyses. More focused intervention strategies could increase the impact and efficiency of screening interventions.
Office-based Vergence and Accommodative Therapy for the Treatment of Intermittent Exotropia: A Pilot Study
Authors: Ma Martin Ming-Leung , Kang Ying , Scheiman Mitchell , Chen Xiang
Published: December 2019

SIGNIFICANCE

This study will help to demonstrate the potential value of office-based vergence/accommodative therapy for the treatment of intermittent exotropia and provide data that can be used for planning future clinical trials.

PURPOSE

This study was designed to evaluate changes in the office control score after office-based vergence/accommodative therapy for intermittent exotropia.

METHODS

This was a prospective, unmasked pilot study. Fourteen Chinese participants aged 6 to 18 years with intermittent exotropia (excluding the convergence insufficiency type) were enrolled. All participants received 60 minutes of office-based vergence/accommodative therapy with home reinforcement once per week for 12 weeks. Therapy included vergence, accommodation, saccades and pursuits, antisuppression, and monocular fixation in binocular field techniques. The primary outcome measure was the change in the office control score from the baseline visit to the 13-week outcome visit.

RESULTS

All participants completed the study. The office control score at distance changed by −1.0 (95% confidence interval [CI] = −1.6 to −0.4; P = .005; Cohen's d effect size, 0.93). The distant Look And Cover, then Ten seconds Observation Scale for Exotropia score and distant Newcastle control score total score changed by −0.7 (95% CI, −1.2 to −0.2; P = .02; Cohen's d effect size, 0.55) and −1.9 (95% CI, −2.8 to −1.0; P < .001; Cohen's d effect size, 1.37), respectively. Although there was no significant change in the angle of distance exodeviation (−1.8 prism diopter [Δ] less exodeviation; 95% CI, −3.74 to 0.14Δ; P = .11), a significant change was observed in the near angle (−4.4Δ less exodeviation; 95% CI, −7.3 to −1.5Δ; P = .01; Cohen's d effect size, 0.79). There was no significant change in stereopsis or the Chinese Intermittent Exotropia Questionnaire score.

CONCLUSIONS

In this select group of children with intermittent exotropia, 12 weeks of office-based vergence/accommodative therapy with home reinforcement resulted in a statistically and clinically significant improvement in the distance control of exodeviation and the near exodeviation magnitude. These results suggest that there is a need for a randomized clinical trial designed to determine the effectiveness of vision therapy as a treatment modality for intermittent exotropia.