bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and validation of a Super learner-based model for predicting survival in Chinese Han patients with resected colorectal cancer
Authors: Li Jiqing , Gu Jianhua , Lu Yuan , Wang Xiaoqing , Si Shucheng , Xue Fuzhong
Published: June 2020

Objective

Improved prognostic prediction for patients with colorectal cancer stays an important challenge. This study aimed to develop an effective prognostic model for predicting survival in resected colorectal cancer patients through the implementation of the Super learner.

Methods

A total of 2333 patients who met the inclusion criteria were enrolled in the cohort. We used multivariate Cox regression analysis to identify significant prognostic factors and Super learner to construct prognostic models. Prediction models were internally validated by 10-fold cross-validation and externally validated with a dataset from The Cancer Genome Atlas. Discrimination and calibration were evaluated by Harrell concordence index (C-index) and calibration plots, respectively.

Results

Age, T stage, N stage, histological type, tumor location, lymph-vascular invasion, preoperative carcinoembryonic antigen and sample lymph nodes were integrated into prediction models. The concordance index of Super learner-based prediction model (SLM) was 0.792 (95% confidence interval: 0.767–0.818), which is higher than that of the seventh edition American Joint Committee on Cancer TNM staging system 0.689 (95% confidence interval: 0.672–0.703) for predicting overall survival (P < 0.05). In the external validation, the concordance index of the SLM for predicting overall survival was also higher than that of tumor-node-metastasis (TNM) stage system (0.764 vs. 0.682, respectively; P < 0.001). In addition, the SLM showed good calibration properties.

Conclusions

We developed and externally validated an effective prognosis prediction model based on Super learner, which offered more reliable and accurate prognosis prediction and may be used to more accurately identify high-risk patients who need more active surveillance in patients with resected colorectal cancer.
Spatiotemporal pattern of interactions between an apex predator and sympatric species
Authors: Prat-Guitart Marta , Onorato David P , Hines James E , Oli Madan K
Published: June 2020

Increases in apex predator abundance can influence the behavior of sympatric species, particularly when the available habitat and/or resources are limited. We assessed the temporal and spatiotemporal interactions between Florida panthers (Puma concolor coryi) and six focal sympatric species in South Florida, where Florida panther abundance has increased by more than 6-fold since the 1990’s. Using camera trap data, we quantified species’ diel activity patterns, temporal overlap, and time-to-encounter (i.e., time between consecutive visits of a Florida panther and a focal species and vice versa). The Florida panther and bobcat (Lynx rufus) displayed a nocturnal activity pattern; the black bear (Ursus americanus), white-tailed deer (Odocoileus virginianus), wild boar (Sus scrofa), and wild turkey (Meleagris gallopavo) were mostly diurnal; and the raccoon (Procyon lotor) was cathemeral. Prey species and black bears minimized encounters with Florida panthers by being active during the day and displaying longer time-to-encounter, whereas Florida panthers visited a site after a prey species at higher probabilities than after competitor species, and were more likely to visit an elevated site or upland habitat. Our results suggest that interactions between Florida panthers and sympatric species in our study system are driven by species-specific behavioral responses. Gaining a better understanding of the crucial interactions driving species coexistence is important for a better understanding of the structure and function of ecological communities and help manage the potential expansion of the Florida panther into Central Florida.
Understanding Racial Microaggressions
Authors: Williams Monnica T.
Published: June 2020

Abstract: This chapter introduces the concept of microaggressions. It reviews stigmatized racial and ethnic identities and the importance of terminology. It outlines the meaning of Whiteness and White racial identity. It then describes and defines what microaggressions are specifically and the research surrounding this concept. Common stereotypes of ethnic and racial groups are outlined. Types of microaggressive behavior include categories termed not a true citizen; racial categorization and sameness; assumptions about intelligence, competence, and status; false color-blindness/invalidating racial or ethnic identity; criminality or dangerousness; denial of individual racism; myth of meritocracy/race is irrelevant for success; reverse racism hostility; pathologizing minority culture or appearance; second-class citizen/ignored; tokenism; attempting to connect using stereotypes; exoticization and eroticization; avoidance and distancing; environmental exclusion; and environmental attacks. Microaggressions in the media and their negative impact on society are described. Distinctions and commonalities between microaggressions and everyday racism as well as other related concepts are analyzed. Microaggressions overlap with some similar concepts, so one cannot study microaggressions without considering these other close constructs and the related literature base. Furthermore, microaggressions are context dependent: A statement that might be microaggressive in one situation may not be a microaggression in another case, and therefore it may be difficult to recognize.
Microaggressions in Therapy
Authors: Williams Monnica T.
Published: June 2020

Abstract: Common therapist microaggressions toward clients, microaggressions toward therapists, and ways to address both issues are discussed in this chapter. It is important for therapists to be conscientious about their presence in terms of providing a welcoming website, an office free of potential microaggressive or unwelcoming content, and basic interactions that are culturally sensitive and nondiscriminatory. There are many ways that a clinician may engage in microaggressive actions, including minimizing cultural experiences, pathologizing cultural values and collectivism, overidentification, trying too hard to be culturally sensitive, engaging in insensitive remarks, and withholding answers from clients of color. Two examples of microaggressions in therapist–client interactions are outlined in which racism is dismissed by a therapist and a client is called a “strong Black woman.” It is important for clinicians to know how to repair the therapeutic alliance if they have engaged in microaggressive behavior either by realizing it later or if a client brings it up. Clients also may engage in microaggressions, and therapists should address these behaviors in session to help increase understanding, awareness, and empathy in clients. Microaggressions against therapists of color from clients and from supervisors are challenging and may not be easy to navigate; some ways of addressing these are outlined.
Helping Clients Manage Microaggressions
Authors: Williams Monnica T.
Published: June 2020

Abstract: This chapter outlines what clinicians can do to help and support clients managing microaggressions. Ten steps are offered to help therapists respond effectively. Detailed examples of listening to a client of color who has experienced a microaggression, supporting a client of color who experienced a microaggression, and processing microaggressions experienced by a client of color are provided. Ongoing microaggressions can lead people of color to engage in maladaptive coping, such as remaining in denial, engaging in substance use, aggression, and self-blame; thus, it is important for therapists to recognize these and support clients to instead engage in adaptive and proactive coping strategies. A therapist can also support clients in how to respond effectively to microaggressions in their daily lives. It is not always possible or safe to respond to a microaggression, but clients should be encouraged to respond if they are able to do so safely. Strategies include making the microaggression more visible, disarming the microaggression, and educating the offender. Another way therapists can help is by encouraging and supporting clients in the exploration of their ethnoracial identities to help improve overall psychological well-being. However, therapists should pay careful attention if a client is unwilling to discuss microaggressions; rather than take it personally or pathologize the client, the therapist should openly acknowledge and validate the client’s mistrust. Microaggression discussion scenarios are outlined to help therapists; these scenarios include profiling by law enforcement, academic conflict, practicum student dress code conflict, and classroom confusion.
The Cognitive Autopsy
Authors: Croskerry Pat
Published: June 2020

Behind heart disease and cancer, medical error is now listed as one of the leading causes of death. Of the medical errors that lead to injury and death, diagnostic failure is regarded as the most significant. Generally, the majority of diagnostic failures are attributed to the clinicians directly involved with the patient, and to a lesser extent, the system in which they work. In turn, the majority of errors made by clinicians is due to decision making failures manifested by various departures from rationality. Of all the medical environments in which patients are seen and diagnosed, the emergency department is the most challenging. It has been described as a ‘wicked’ environment where illness and disease may range from minor ailments and complaints to severe, life-threatening disorders.

The Cognitive Autopsy is a novel strategy towards understanding medical error and diagnostic failure in 42 clinical cases with which the author was directly involved or became aware of at the time. Essentially, it describes a cognitive approach towards root cause analysis of medical adverse events or near misses. Whereas root cause analysis typically focuses on the observable and measurable aspects of adverse events, the cognitive autopsy attempts to identify covert cognitive processes that may have contributed to outcomes. In this clinical setting, no cognitive process is directly observable but must be inferred from the behaviour of the individual clinician. The book illustrates unequivocally that chief among these cognitive processes are cognitive biases and other flaws in decision making, rather than knowledge deficits.
The Fortunate Footballer
Authors: Croskerry Pat
Published: June 2020

This case illustrates the importance of context and the dangers of curbside/corridor consultations. In the process, insufficient unpacking of information occurs, and the patient is misdiagnosed. Diagnosis momentum occurs, resulting in a near-fatal outcome.
Lazarus Redux
Authors: Croskerry Pat
Published: June 2020

In this case, a 65-year-old male presents to the emergency department of a teaching hospital late in the evening with left-sided weakness that had started approximately 2 hours earlier. He also complains of mild pan-cranial headache and nausea, both of which started at the same time as the weakness. His physical examination is normal other than marked weakness and increased reflexes on the left side. A computed tomography scan is completed and appears normal. A referral is made to neurology describing the stable condition of the patient and the diagnosis of a non-hemorrhagic cerebrovascular accident. Medication is ordered for his nausea. Soon after, the patient becomes unresponsive with a significant drop in respiratory rate. The emergency physician assumes the patient is experiencing “a stroke in evolution” and calls neurology immediately. However, the diagnosis proves premature when another cause for the sudden deterioration of the patient is discovered.
Postpartum Puzzler
Authors: Croskerry Pat
Published: June 2020

In this case, a 24-year-old female presents to the emergency department (ED) of a community hospital late in the evening. At triage, she is weeping, distressed, very anxious, and complaining of paresthesias in her extremities. She had a normal vaginal delivery approximately 4 weeks ago and has been healthy since. The ED physician is asked to do a quick assessment as the ED is about to close. A consensus quickly develops among the staff that the patient probably has postpartum depression and could be managed through the mental health crisis team in daytime hours the following day. Her physical exam is normal other than some weakness in both legs. The physician feels uncomfortable with the patient’s presentation and considers the possibility of an uncommon neurological disorder. The neurology service reluctantly accepts the patient though doubting the physician’s diagnosis. He later learns that his zebra was correct.
Explosions, Expletives, and Erroneous Explanations
Authors: Croskerry Pat
Published: June 2020

The case of a French-speaking 14-year-old female presenting to an emergency department is reviewed. She has explosive, uncontrollable diarrhea, which provides a significant challenge for the nurses, who have difficulty maintaining a clean environment. Considerable confusion arises over her actual diagnosis, complicated by language problems and an unusual sequence of events.
A Search Satisfied Skateboarder
Authors: Croskerry Pat
Published: June 2020

In this case, a clinical clerk sees a young male who has sustained an injury to his hand while skateboarding. She focuses on his middle finger and orders an X-ray. It shows a fracture at the proximal interphalangeal joint, often associated with injuries to the volar plate. In the course of reviewing the case with the attending physician, further injuries come to light. The case is a good example of search satisficing bias, the tendency to call off a search before it is complete. Search satisficing is probably one of the older “evolutionary” biases and is the second most common error in radiology.
The Vacillated Vagrant
Authors: Croskerry Pat
Published: June 2020

In this case, a middle-aged male is brought to the emergency department of a tertiary care hospital from the airport. He has had an episode of shortness of breath and chest tightness, associated with nausea, paresthesias, and headache. Initially, he undergoes a cardiac workup and is cleared of any problems with his heart. He is discharged to the community and advised to return if there is any recurrence of symptoms. He does return for a further four visits over a 2-week period, during which he is referred to various other disciplines and services before his correct diagnosis is made. The case illustrates how a variety of biases influence the course of his management, notably diagnosis momentum, fundamental attribution error, and affective bias.
Sweet Nothings
Authors: Croskerry Pat
Published: June 2020

In this case, a young female presents to a community hospital complaining of headache. She has a history of migraine and reports that this headache feels typical. Routine blood work is drawn, and treatment is begun for her headache. However, before it is initiated, she has a seizure and is rendered comatose. A diagnosis of subarachnoid hemorrhage is made. She is intubated and transferred to another hospital for a computed tomography scan of her head. In the meantime, her blood work is returned, which reveals the cause of her seizure and her correct diagnosis. The case illustrates the potential benefit of medical caveats (cognitive forcing strategies).
Conclusion
Authors: Croskerry Pat
Published: June 2020

In the past two decades, there has been growing interest in the process of clinical decision making (CDM). Importantly, a strong interest has flourished in the process of diagnosis, particularly its failure rate. Two major strategies have been proposed to ameliorate diagnostic failure: minimizing system error and strategies to promote optimal clinical decision making. Many health care environments are not optimal. A variety of factors have been identified that influence the safe operation of the system, and clinicians need to be cognizant of them. In this chapter, a number of strategies are reviewed to optimize the CDM that occurs within the system, including the promotion of rationality, metacognition, thinking skills, flexibility, innovation and creativity in thinking, lateral thinking, cognitive bias mitigation, the incorporation of artificial intelligence, and distributed cognition. Instead of assuming that competence in CDM will be tacitly acquired in the course of medical education, clinicians need to advocate for explicit interventions that are known to raise the caliber of CDM.
Postpartum Mental Health Disorders: A Casebook
Authors: Committee on Gender and Mental Health Group for the Advancement of Ps...
Published: June 2020

Postpartum Mental Health Disorders: A Casebook describes the recognition and management of psychiatric disorders that present in the postpartum period. Case vignettes illustrate the type of complaints that may present to the psychiatrist, primary care physician, obstetrician, nurse practitioner, doula, or other health care professionals. Chapters cover depression, anxiety disorders, obsessive compulsive disorder, psychotic disorders, bipolar disorders, posttraumatic stress disorders, personality disorders, and drug abuse. Each chapter includes information about differential and provisional diagnoses, epidemiology, treatment, and prognosis with advice as to when to refer to a specialist. More general chapters address risk factors for developing postpartum disorders, prevention, and the uses and safety of psychotropic medication during breastfeeding. Two frequently used screening questionnaires are included with instructions as to use. Some key references or links are included.
Postpartum Personality Disorders
Authors: Apter Gisele , Robinson Gail Erlick
Published: June 2020

This chapter on personality disorders in the postpartum reviews the impact on the well-being of the mother and the infant if the mother suffers from a pre-existing personality disorder. Borderline personality disorders may have a negative impact on the new mother’s ability to form a healthy relationship with the infant and may become frustrated easily frustrated if the infant doesn’t obey. Women with dependent personality disorders may feel needy, helpless, and indecisive and therefore feel overwhelmed with motherhood. New mothers with paranoid personality disorders feel generally distrusting and suspicious. They may reject the health-care worker’s advice, thereby putting the infant at risk. Working with the mother–infant dyad is essential.
Disorders of Attachment
Authors: Mittal Leena P.
Published: June 2020

This chapter on disorders of attachment addresses the causes and consequences of impaired attachment between mothers and their fetuses or infants. Mothers’ feelings of attachments for their babies generally begins during pregnancy, grows with quickening, and continues after the delivery. Women who have an unwanted pregnancy or who suffer from anxiety, depression, or a psychotic disorder during pregnancy may feel detached from the developing fetus. Postpartum, it is important to assess for these disorders as well as a painful, traumatic delivery, as they may continue to interfere with attachment. Generally, treatment of the underlying disorder allows the woman to begin bonding with the baby. This chapter describes how to recognize and manage factors that may be interfering with attachment. Working with the mother and the baby can assist in building bonds.
Too Much Contact
Authors: Gutierrez Christie , Khaitan Anisha
Published: June 2020

Trauma is the leading cause of death in children, accounting for more than 50% of all childhood deaths. Pediatric trauma patients differ from adult patients in several respects, and understanding these nuances is critical to their successful management. After presenting the case of an 8-year-old female struck by a moving vehicle, this chapter discusses the management of the pediatric trauma patient. It focuses on the primary and secondary survey with anatomic and physiologic concerns specific to the pediatric patient. After reading this case-based chapter, the learner should leave with a clear and systematic approach to the management of the pediatric trauma patient with suggested reading provided for further in-depth study.
Let’s Do the Twist
Authors: Malia Laurie , Rabiner Joni E.
Published: June 2020

Ankle injuries are a common presentation to the pediatric emergency department, with ankle sprains significantly more common than ankle fractures. This chapter presents a child with a swollen, painful ankle after a sports injury. Evaluation of ankle injuries is discussed, including use of clinical decision rules such as the Ottawa Ankle Rules and the Low Risk Ankle Rule, which help determine who is at low risk for ankle fracture and may not need radiographic imaging. Classification of fractures in children with open physes using the Salter-Harris nomenclature is reviewed. Management of ankle injuries, including bracing, splinting, casting, need for urgent orthopedic consultation, follow-up, and healing are also discussed.
Where Do These Puzzle Pieces Go?
Authors: Raza Mir , Reda Lara
Published: June 2020

Pediatric elbow films can be challenging: What is normal versus abnormal? It is critically important to understand the normal development of the elbow and how to identify normal ossification centers and any fractures. Skeletal differences occur due to age and sex, and the relationship between landmarks can help distinguish what is truly an injury versus a normal developmental variant. In this chapter we review methods to review pediatric plain radiographs to identify pediatric elbow fractures, particularly supracondylar humeral fractures.
Basaglia’s international influence
Authors: Saraceno Benedetto , Sashidharan Sashi P.
Published: June 2020

This chapter tries to answer the question of whether the thinking and the work of Franco Basaglia are widespread and influential outside Italy. In the 1970s, Basaglia had a remarkable impact both on the new Spanish psychiatry and also in Brazil where, through a series of lectures, he inspired the early stages of the Brazilian Psychiatric Reform. Since Basaglia’s premature death in 1980, his vision and thinking have continued to influence psychiatric practice and mental health reform. However, distortion of Basaglia’s thinking may be present in some psychiatric literature. The most common distortions about Basaglia can be summarized as follows: (1) Basaglia belonged to the movement of anti-psychiatry; (2) Basaglia’s approach was driven by ideology; and (3) Basaglia’s work was essentially inspired by a philanthropic impetus. All three statements are inaccurate and essentially wrong: they will be challenged by the authors of this chapter.
From the asylum to community mental health services
Authors: Mauri Diana , Barcala Alejandra
Published: June 2020

This chapter intends to give insight into the tensions generated in Argentinian mental healthcare by alternations in policies and practices, while analysing Basaglia’s influence on policy making, on the development of mental health services, and on professional cultures. Basaglia’s thoughts and Italian reform have had a major impact in Argentina, thanks to his successors in the Trieste Department of Mental Health and the work they have carried out in the last 30 years. The core of his activity and reflections has become a guiding light in the protection of social and civil rights and the fight against traditional psychiatric power. Italian mental health reform is considered to be a central reference for Argentina’s National Mental Health Law 26657, passed in 2010; but even legislation which is human rights oriented still has to fully guarantee a system of mental healthcare respectful of people’s dignity and freedom.
Franco Basaglia
Authors: Kelly Brendan D.
Published: June 2020

If history is the story of what happened, then Franco Basaglia appears to have no place in the history of psychiatry in Ireland. But if history is also the story of what did not happen, Basaglia is surely one of the seminal non-events in the history of Irish psychiatry. He is not alone. He joins the unlikely company of the Roman Catholic Church and psychoanalysis in conspicuously failing to shape Irish psychiatry to any substantial degree. The reasons are complex. The Irish asylums were profoundly social creations rather than medical ones, and deinstitutionalization, when it arrived in earnest in the 1970s, found its roots in broader social change, human rights, and pragmatism. Irish psychiatry has always been wary of abstract thought. So, while a few reforming and critical psychiatrists were influenced by Basaglian ideas, Basaglia himself remained—and remains—curiously absent from public psychiatric discourse in Ireland.
Asylum
Authors: Spandler Helen
Published: June 2020

Psichiatria Democratica, the Italian democratic psychiatry movement, may have had little impact on mainstream psychiatry in the UK. However, developments in Trieste provided ongoing inspiration to a significant number of mental health workers and activists, especially in the North of England from the mid 1980s onwards. They tried to use community care policies as an opportunity to develop more democratic mental health services. These developments were often featured in Asylum: the magazine for democratic psychiatry, which was directly inspired by Psichiatria Democratica. Asylum magazine still exists as one of the few concrete legacies of the movement in the UK. This chapter uses research into the first 30 years of the magazine as a vehicle to explore the influence of the Italian democratic psychiatry movement in the UK. It argues that Asylum magazine continues the struggle for democratic psychiatry, adapted for contemporary times.
Procedural Volume Within Military Treatment Facilities—Implications for a Ready Medical Force
Authors: Carius Brandon M , April Michael D , Schauer Steve G
Published: June 2020

Introduction

Consistent procedural volume is important for emergency physicians (EPs) to maintain opportunities for critical lifesaving skills. While non-EP literature demonstrates improved patient outcomes with higher volumes, few studies examine the optimal number of repetitions needed to maintain procedural competency in EP populations. The largely young, healthy active duty population that constitutes the majority of patients in military treatment facilities (MTFs) decreases the likelihood to utilize emergent procedures. Despite this likelihood, EPs are expected to maintain proficiency and readiness to perform critical procedures in deployed settings.

Materials and Methods

A retrospective analysis of de-identified data obtained through the Military Health System Mart was performed for procedural codes involving surgical airway, central venous access, and intubation. Data were sought for 2014–2016 calendar years from seven Army hospitals under the Southwest Region Medical Command. Procedural numbers were obtained for both overall volume and those performed per 1,000 encounters. Additionally, we analyzed for volume differences with the highest volume MTF (Brooke Army Medical Center [BAMC]) removed from the data set.

Results

A total of 1,450 procedures were performed among the MTFs analyzed, including 973 intubations, 473 central venous catheter placements, and 4 surgical airways. MTFs averaged 69.5 intubations and 38.8 venous catheters placed each year, but decreased to 28.1 intubations and 13.0 venous catheters placed annually when BAMC was removed from the data set (a 59.6 and 61.6% decrease, respectively). Monthly averages of 40.5 intubations and 19.7 central venous catheterizations per month among all included MTFs decreased to 14.0 and 6.5 when BAMC was removed. All surgical airways were performed at BAMC. Procedural frequency per 1,000 encounters was highest at BAMC, although ordinal differences were noted in the remaining six MTFs compared with overall procedural volumes.

Conclusions

This retrospective analysis demonstrates a significant variation in procedural volumes across MTFs, illustrating disproportionate opportunities for procedural skill maintenance among Army EPs. Low procedural volume threatens the maintenance of critical EP skills. These numbers could also suggest low skills for other providers (such as physician assistants), further illustrating decreased skill readiness throughout the force. Further research is needed to examine procedural volumes per individual EP, as well as those performed by other providers to evaluate for overall procedural readiness across the military force.
Measures to Limit COVID-19 Outbreak Effects Among Military Personnel: Preliminary Data
Authors: Segal David , Rotschield Jacob , Ankory Ran , Kutikov Sergey , Moaddi Bian , Verhovsky Guy , Benov Avi , Twig Gilad , Glassberg Elon , Fink Noam , Bader Tarif , Karp Erez
Published: June 2020

Introduction

The COVID-19 outbreak posed a threat to the readiness of military forces as well as their ability to fulfill missions. Seeing that military forces have been encountering similar challenges, we found it eminent to share the Israeli Defense Force (IDF) Northern Command’s (NC) preliminary experience.

Materials and Methods

We retrospectively summarized the actions that were taken by our team, focusing on 18 battalions at the Israeli NC. These actions included promoting a series of organizational changes in terms of social distancing and medical regulations as well as working to strengthen medical leadership through designated video meetings with medical commanders across our organization. Meetings included relevant clinical education, updates, and leadership building. These actions and others were aimed to increase our influence on the decision-making processes. While we conducted real-time reverse transcriptase polymerase chain reaction SARS-CoV-2 laboratory tests for soldiers who were suspected to have COVID-19 (those presenting with compatible signs and symptoms after having been exposed to a confirmed COVID-19 patient), we were not able to screen healthy populations, nor did we have serum antibody serologic tests available during the study period. We reviewed the COVID-19 outbreak national data, obtained from Ministry of Health publishings and the IDF databases. Data were included from February 26th, 2020 (day 0, first COVID-19 patient in Israel) to April 19th, 2020 (day 53, about 1 month after most of the COVID-19 regulation were issued in the NC).

Results

The mean age of the battalion soldiers was 21.29 ± 4.06 (range 18–50), 81.34% male. Most restrictions were issued on day 18. On day 53, 98.85% of the personnel in the battalions were kept active and asymptomatic in their units.

Conclusions

Despite the limited availability of laboratory testing for COVID-19 our actions enabled us to lead a strict risk-management policy while maintaining most of the available workforce.
Multipole expansion for H i intensity mapping experiments: simulations and modelling
Authors: Cunnington Steven , Pourtsidou Alkistis , Soares Paula S , Blake Chris , Bacon David
Published: June 2020

We present a framework and an open-source python toolkit to analyse the two-point statistics of 3D fluctuations in the context of H i intensity maps using the multipole expansion formalism. We include simulations of the cosmological H i signal using N-body and lognormal methods, foregrounds and their removal, as well as instrumental effects. Using these simulations and analytical modelling, we investigate the impact of foreground cleaning and the instrumental beam on the power spectrum multipoles as well as on the Fourier space clustering wedges. We find that both the instrumental beam and the foreground removal can produce a quadrupole (and a hexadecapole) signal, and demonstrate the importance of controlling and accurately modelling these effects for precision radio cosmology. We conclude that these effects can be modelled with reasonable accuracy using our multipole expansion technique. We also perform a Markov Chain Monte Carlo (MCMC) analysis to showcase the effect of foreground cleaning on the estimation of the H i abundance and bias parameters. The accompanying python toolkit is available at https://github.com/IntensityTools/MultipoleExpansion, and includes an interactive suite of examples to aid new users.
Uncovering distinct environments in an extended physical system around the W33 complex
Authors: Dewangan L K , Baug T , Ojha D K
Published: June 2020

We present a multiwavelength investigation of a large-scale physical system containing the W33 complex. The extended system (∼50 pc × 37 pc) is selected based on the distribution of molecular gas at [29.6, 60.2] km s−1 and of 88 ATLASGAL 870-μm dust clumps at d ∼2.6 kpc. The extended system/molecular cloud traced in the maps of 13CO and C18O emission contains several H ii regions excited by OB stars (age ∼0.3–1.0 Myr) and a thermally supercritical filament (fs1, length ∼17 pc). The filament, which is devoid of ionized gas, shows a dust temperature (Td) of ∼19 K, while the H ii regions have a Td of ∼21–29 K. It suggests the existence of two distinct environments in the cloud. The distribution of Class I young stellar objects (mean age ∼0.44 Myr) traces the early stage of star formation (SF) towards the cloud. At least three velocity components (around 35, 45 and 53 km s−1) are investigated towards the system. The analysis of 13CO and C18O reveals spatial and velocity connections of cloud components at around 35 and 53 km s−1. The observed positions of previously known sources, W33 Main, W33 A and O4–7I stars, are found towards a complementary distribution of these two cloud components. The filament fs1 and a previously known object W33 B are seen towards the overlapping areas of the clouds, where ongoing SF activity is evident. A scenario related to converging/colliding flows from two different velocity components appears to explain well the observed indications of SF activity in the system.
Linking the small-scale relativistic winds and the large-scale molecular outflows in the z = 1.51 lensed quasar HS 0810+2554
Authors: Chartas G , Davidson E , Brusa M , Vignali C , Cappi M , Dadina M , Cresci G , Paladino R , Lanzuisi G , Comastri A
Published: June 2020

We present Atacama Large Millimeter/submillimeter Array (ALMA) observations of the quadruply lensed z =  1.51 quasar HS 0810+2554 which provide useful insight on the kinematics and morphology of the CO molecular gas and the ∼ 2 mm-continuum emission in the quasar host galaxy. Lens modelling of the mm-continuum and the spectrally integrated CO(J = 3→2) images indicates that the source of the mm-continuum has an eccentricity of e ∼ 0.9 with a size of ∼1.6 kpc and the source of line emission has an eccentricity of e ∼ 0.7 with a size of ∼1 kpc. The spatially integrated emission of the CO(J = 2→1) and CO(J = 3→2) lines shows a triple peak structure with the outer peaks separated by Δv21 = 220 ± 19 km s−1 and Δv32 = 245 ± 28 km s−1, respectively, suggesting the presence of rotating molecular CO line emitting gas. Lensing inversion of the high spatial resolution images confirms the presence of rotation of the line emitting gas. Assuming a conversion factor of αCO = 0.8 M⊙ (K km s−1 pc2)−1 we find the molecular gas mass of HS 0810+2554 to be MMol = (5.2 ± 1.5)/μ32 × 1010 M⊙, where μ32 is the magnification of the CO(J = 3→2) emission. We report the possible detection, at the 3.0–4.7σ confidence level, of shifted CO(J = 3→2) emission lines of high-velocity clumps of CO emission with velocities up to 1702 km s−1. We find that the momentum boost of the large-scale molecular wind is below the value predicted for an energy-conserving outflow given the momentum flux observed in the small-scale ultrafast outflow.
The post-maximum behaviour of the changing-look Seyfert galaxy NGC 1566
Authors: Oknyansky V L , Winkler H , Tsygankov S S , Lipunov V M , Gorbovskoy E S , van Wyk F , Buckley D A H , Jiang B W , Tyurina N V
Published: June 2020

We present results of the long-term multiwavelength study of optical, UV, and X-ray variability of the nearby changing-look (CL) Seyfert NGC 1566 observed with the Swift Observatory and the MASTER Global Robotic Network from 2007 to 2019. We started spectral observations with South African Astronomical Observatory 1.9-m telescope soon after the brightening was discovered in July 2018 and present here the data for the interval between 2018 August and 2019 September. This paper concentrates on the remarkable post-maximum behaviour after 2018 July when all bands decreased with some fluctuations. We observed three significant re-brightenings in the post-maximum period during 2018 November 17–2019 January 10, 2019 April 29–2019 June 19, and 2019 July 27–2019 August 6. An X-ray flux minimum occurred in 2019 March. The UV minimum occurred about 3 months later. It was accompanied by a decrease of the LUV/LX-ray ratio. New post-maximum spectra covering (2018 November 31–2019 September 23) show dramatic changes compared to 2018 August 2, with fading of the broad lines and [Fe X] λ6374 until 2019 March. These lines became somewhat brighter in 2019 August–September. Effectively, two CL states were observed for this object: changing to type 1.2 and then returning to the low state as a type 1.8 Sy. We suggest that the changes are due mostly to fluctuations in the energy generation. The estimated Eddington ratios are about 0.055 ${{\ \rm per\ cent}}$ for minimum in 2014 and 2.8 ${{\ \rm per\ cent}}$ for maximum in 2018.
Uncovering the orbit of the hercules dwarf galaxy
Authors: Gregory Alexandra L , Collins Michelle L M , Erkal Denis , Tollerud Erik , Delorme Maxime , Hill Lewis , Sand David J , Strader Jay , Willman Beth
Published: June 2020

We present new chemo-kinematics of the Hercules dwarf galaxy based on Keck II-DEIMOS spectroscopy. Our 21 confirmed members, including 9 newly confirmed members, have a systemic velocity of vHerc = 46.4 ± 1.3 km s−1 and a velocity dispersion $\sigma _{v,\mathrm{Herc}}=4.4^{+1.4}_{-1.2}$ km s−1, consistent with previous studies. From the strength of the Ca ii triplet, we obtain a metallicity of [Fe/H] = −2.48 ± 0.19 dex and dispersion of $\sigma _{\rm {[Fe/H]}}= 0.63^{+0.18}_{-0.13}$ dex. This result is within 1σ of previous measurements, and makes Hercules a particularly metal-poor galaxy, placing it slightly below the standard mass–metallicity relation. Previous photometric and spectroscopic evidence suggests that Hercules is tidally disrupting and may be on a highly radial orbit. From our identified members, we measure no significant velocity gradient. By cross-matching with the second Gaia data release, we determine an uncertainty-weighted mean proper motion of $\mu _{\alpha }^*=\mu _{\alpha }\cos (\delta)=-0.153\pm {0.074}$ mas yr−1, μδ = −0.397 ± 0.063 mas yr−1. This proper motion is slightly misaligned with the elongation of Hercules, in contrast to models which suggest that any tidal debris should be well aligned with the orbital path. Future observations may resolve this tension.
The X-ray emission in young radio active galactic nuclei
Authors: Liao Mai , Gu Minfeng , Zhou Minhua , Chen Liang
Published: June 2020

In this work, we investigated the X-ray emission for a sample of young radio active galactic nuclei (AGNs) by combining data from Chandra/XMM–Newton with data for other wavebands. We find strong correlations between the X-ray luminosity LX at 2–10 keV and the radio luminosities LR at 5 GHz for the VLBI radio-core, VLA radio-core and Faint Images of the Radio Sky at Twenty-Centimeters (FIRST) component, indicating that both parsec- and kiloparsec-scale radio emissions are strongly correlated with X-ray emission in these sources. We find an approximately linear dependence of the radio on the X-ray luminosity in the sources with radiatively efficient accretion flows (i.e. the Eddington ratio Redd ≳ 10−3), with b ∼ 1 ($L_{\rm R}\, \propto \, L_{\rm X} ^{b}$) and $\xi _{\rm RX}\, \sim$ 1 in the fundamental plane using the VLBI data. The dependence is consistent with the re-analysed results of a previous study of Fan and Bai at Redd ≳ 10−3, but is significantly different from the theoretical prediction of accretion flow as the origin of X-ray emission. In contrast to the case for radio-quiet quasars, there is no significant correlation between Γ and the Eddington ratio. Our results seem to indicate that the X-ray emission of high-accretion young radio AGNs may be from the jet. We constructed the spectral energy distributions (SEDs) for 18 sources (most of which are in radiatively efficient accretion), namely nine galaxies and nine quasars with high-quality X-ray data, and find that the X-ray emission of most quasars is more luminous than that of normal radio-quiet quasars. This is clearly seen from the quasar composite SED, in which the X-ray emission is apparently higher than that of radio-quiet quasars, probably supporting jet-related X-ray emission in young radio AGNs. The possibility that the X-ray emission is from self-synchrotron Compton is discussed.
MR imaging features of diffuse intrinsic pontine glioma and relationship to overall survival: report from the International DIPG Registry
Authors: Leach James L , Roebker James , Schafer Austin , Baugh Joshua , Chaney Brooklyn , Fuller Christine , Fouladi Maryam , Lane Adam , Doughman Renee , Drissi Rachid , DeWire-Schottmiller Mariko , Ziegler David S , Minturn Jane E , Hansford Jordan R , Wang Stacie S , Monje-Deisseroth Michelle , Fisher Paul G , Gottardo Nicholas G , Dholaria Hetal , Packer Roger , Warren Katherine , Leary Sarah E S , Goldman Stewart , Bartels Ute , Hawkins Cynthia , Jones Blaise V
Published: June 2020

Abtract

Background

This study describes imaging features of diffuse intrinsic pontine glioma (DIPG) and correlates with overall survival (OS) and histone mutation status in the International DIPG Registry (IDIPGR).

Methods

Four hundred cases submitted to the IDIPGR with a local diagnosis of DIPG and baseline MRI were evaluated by consensus review of 2 neuroradiologists; 43 cases were excluded (inadequate imaging or alternative diagnoses). Agreement between reviewers, association with histone status, and univariable and multivariable analyses relative to OS were assessed.

Results

On univariable analysis imaging features significantly associated with worse OS included: extrapontine extension, larger size, enhancement, necrosis, diffusion restriction, and distant disease. On central review, 9.5% of patients were considered not to have DIPG. There was moderate mean agreement of MRI features between reviewers. On multivariable analysis, chemotherapy, age, and distant disease were predictors of OS. There was no difference in OS between wild-type and H3 mutated cases. The only imaging feature associated with histone status was the presence of ill-defined signal infiltrating pontine fibers.

Conclusions

Baseline imaging features are assessed in the IDIPGR. There was a 9.5% discordance in DIPG diagnosis between local and central review, demonstrating need for central imaging confirmation for prospective trials. Although several imaging features were significantly associated with OS (univariable), only age and distant disease were significant on multivariable analyses. There was limited association of imaging features with histone mutation status, although numbers are small and evaluation exploratory.
False Rifampicin Resistance in Xpert Ultra Applied to Lymph Node Aspirate: A Case Report
Authors: Ng Kamela C S , Rigouts Leen , de Jong Bouke C , Lynen Lutgarde
Published: June 2020

A 36-year-old male patient was diagnosed with tuberculosis in Antwerp, Belgium, in May 2018. His lymph node aspirate initially tested rifampicin resistant in Xpert MTB/RIF Ultra, but tested susceptible in all other tests including targeted deep sequencing due to a rare matrix effect in the Xpert MTB/RIF Ultra reaction tube.
Determinants of the patient global assessment of well-being in early axial spondyloarthritis: 5-year longitudinal data from the DESIR cohort
Authors: Hirano Fumio , van der Heijde Désirée , van Gaalen Floris A , Landewé Robert B M , Gaujoux-Viala Cécile , Ramiro Sofia
Published: June 2020

Objectives

To investigate the determinants of patient well-being over time, and the influence of age, gender and education in patients with early axial spondyloarthritis (axSpA).

Methods

Five-year data from DESIR, a cohort of early axSpA, were analysed. The outcome was the BAS-G over 5 years. Generalized estimating equations (GEE) were used to test the relationship between potential explanatory variables from five outcome domains (disease activity, physical function, spinal mobility, structural damage and axial inflammation) and BAS-G over time. Longitudinal relationships were analysed using an autoregressive GEE model. Age, gender and educational level were tested as effect modifiers or confounders.

Results

A total of 708 patients were included. Higher BASDAI questions on fatigue [β (95% CI): 0.17 (0.13, 0.22)], back pain [0.51 (0.46, 0.56)], peripheral joint pain [0.08 (0.04, 0.12)] and severity of morning stiffness [0.08 (0.03–0.13)], and higher BASFI [0.14 (0.08, 0.19)] were associated with a higher BAS-G. In the autoregressive model, the same variables except for morning stiffness were associated with a worsening in BAS-G. Age, gender and educational level were neither effect modifiers nor confounders.

Conclusion

A higher level of back pain is associated with a worsening of patient well-being, as are, though to a lesser extent, higher levels of fatigue, peripheral joint pain and physical disability. Age, gender and educational level do not have an impact on these relationships.
Ultrasound for the diagnosis of gout—the value of gout lesions as defined by the Outcome Measures in Rheumatology ultrasound group
Authors: Christiansen Sara Nysom , Østergaard Mikkel , Slot Ole , Fana Viktoria , Terslev Lene
Published: June 2020

Objective

To evaluate ultrasound for diagnosing gout using consensus-based Outcome Measures in Rheumatology ultrasound definitions of gout lesions.

Methods

Ultrasound was performed in patients with clinically suspected gout. Joints (28) and tendons (26) were binarily evaluated for the Outcome Measures in Rheumatology gout lesions—double contour (DC), tophus, aggregates and erosions. Ultrasound assessment was compared with two reference standards: (i) presence of MSU crystals in joint/tophus aspirate (primary outcome) and (ii) ACR/EULAR 2015 gout classification criteria (secondary outcome). Both reference standards were evaluated by rheumatologists blinded to ultrasound findings. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of each ultrasound lesion against both reference standards were determined.

Results

Eighty-two patients (70 men), mean age 62.4 (range 19–88) years, were included. Fifty-seven patients were MSU-positive whereas 25 patients were MSU-negative (no MSU crystals: 23; aspiration unsuccessful: 2). Of these 25 patients, three patients were classified as ACR/EULAR-positive (i.e. totally 60 ACR/EULAR-positive patients). All ultrasound lesions had high sensitivities for gout (0.77–0.95). DC and tophus showed high specificities (0.88–0.95), positive predictive values (0.94–0.98) and accuracies (0.82–0.84) when both reference standards were used. In contrast, low specificities were found for aggregates and erosions (0.32–0.59). Ultrasound of MTP joints for DC or tophus, knee joint for DC and peroneus tendons for tophus was sufficient to identify all MSU-positive patients with ultrasound signs of gout at any location.

Conclusion

Ultrasound-visualized DC and tophus, as defined by the Outcome Measures in Rheumatology ultrasound group, show high specificities, positive predictive values and accuracies for diagnosing gout and are therefore valid tools in clinical practice.