bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Fermi–LAT Galactic Center Excess: Evidence of Annihilating Dark Matter?
Authors: Murgia Simona 
Published: October 2020

The center of the Galaxy is one of the prime targets in the search for a signal of annihilating (or decaying) dark matter. If such a signal were to be detected, it would shed light on one of the biggest mysteries in physics today: What is dark matter? Fundamental properties of the particle nature of dark matter, such as its mass, annihilation cross section, and annihilation final states, could be measured for the first time. Several experiments have searched for such a signal, and some have measured excesses that are compatible with it. A long-standing and compelling excess is observed in γ-rays by the Fermi Large Area Telescope ( Fermi–LAT). This excess is consistent with a dark matter particle with a mass of approximately 50 (up to ∼200) GeV annihilating with a velocity-averaged cross section of ∼10−26 cm3 s−1. Although a dark matter origin of the excess remains viable, other interpretations are possible. In particular, there is some evidence that the excess is produced by a population of unresolved point sources of γ-rays—for example, millisecond pulsars. In this article, I review the current status of the observation of the Fermi–LAT Galactic center excess, the possible interpretations of the excess, the evidence and counterevidence for each, and the prospects for resolving its origin with future measurements.
Dimensionless Index in Patients With Low-Gradient Severe Aortic Stenosis and Preserved Ejection Fraction
Authors: Altes Alexandre , Thellier Nicolas , Rusinaru Dan , Marsou Wassima , Bohbot Yohann , Chadha Gagandeep , Leman Blandine , Paquet Pierre , Ennezat Pierre Vladimir , Tribouilloy Christophe , Maréchaux Sylvestre 
Published: October 2020

Background
Risk stratification of patients with low-gradient (LG) severe aortic stenosis (AS) despite preserved left ventricular ejection fraction remains challenging. We sought to evaluate the relationship between the dimensionless index (DI)—the ratio of the left ventricular outflow tract time-velocity integral to that of the aortic valve jet—and mortality in these patients.

Methods

Seven hundred fifty-five patients with LG severe AS (defined by aortic valve area ≤1 cm
2
or aortic valve area indexed to body surface area ≤0.6 cm
2
/m
2
and mean aortic pressure gradient <40 mm Hg) and preserved left ventricular ejection fraction ≥50% were studied. Flow status was defined according to stroke volume index <35 mL/m
2
(low flow, LF) or ≥35 mL/m
2
(normal flow, NF).

Results

After adjustment for age, sex, body mass index, Charlson comorbidity index, history of hypertension, history of atrial fibrillation, AS-related symptoms, left ventricular ejection fraction, indexed left ventricular ventricular mass, aortic valve area, and aortic valve replacement as a time-dependent covariate, patients with LG-LF and DI<0.25 exhibited a considerable increased risk of death compared with patients with LG-NF and DI≥0.25 (adjusted hazard ratio, 2.41 [95% CI, 1.61–3.62];
P
<0.001), LG-NF and DI<0.25 (adjusted hazard ratio, 1.84 [95% CI, 1.24–2.73];
P
=0.003), and LG-LF and D≥0.25 (adjusted hazard ratio, 2.27 [95% CI, 1.42–3.63];
P
<0.001). In contrast, patients with LG-LF and DI≥0.25, LG-NF and DI<0.25, and LG-NF and DI≥0.25 had similar outcome. DI<0.25 showed incremental prognostic value in patients with LG-LF severe AS but not in patients with LG-NF severe AS.

Conclusions
Among patients with LG severe AS and preserved left ventricular ejection fraction, decreased DI<0.25 is a reliable parameter in patients with LF to identify a subgroup of patients at higher risk of death who may derive benefit from aortic valve replacement.
Altered Acylcarnitine Metabolism Is Associated With an Increased Risk of Atrial Fibrillation
Authors: Smith Einar , Fernandez Celine , Melander Olle , Ottosson Filip 
Published: October 2020

Background
Atrial fibrillation (AF) is the most common cardiac arrhythmia, but the pathogenesis is not completely understood. The application of metabolomics could help in discovering new metabolic pathways involved in the development of the disease.

Methods and Results
We measured 112 baseline fasting metabolites of 3770 participants in the Malmö Diet and Cancer Study; these participants were free of prevalent AF. Incident cases of AF were ascertained through previously validated registers. The associations between baseline levels of metabolites and incident AF were investigated using Cox proportional hazard models. During 23.1 years of follow‐up, 650 cases of AF were identified (incidence rate: 8.6 per 1000 person‐years). In Cox regression models adjusted for AF risk factors, 7 medium‐ and long‐chain acylcarnitines were associated with higher risk of incident AF (hazard ratio [HR] ranging from 1.09; 95% CI, 1.00–1.18 to 1.14, 95% CI, 1.05–1.24 per 1 SD increment of acylcarnitines). Furthermore, caffeine and acisoga were also associated with an increased risk (HR, 1.17; 95% CI, 1.06–1.28 and 1.08; 95% CI, 1.00–1.18, respectively), while beta carotene was associated with a lower risk (HR, 0.90; 95% CI, 0.82–0.99).

Conclusions
For the first time, we show associations between altered acylcarnitine metabolism and incident AF independent of traditional AF risk factors in a general population. These findings highlight metabolic alterations that precede AF diagnosis by many years and could provide insight into the pathogenesis of AF. Future studies are needed to replicate our finding in an external cohort as well as to test whether the relationship between acylcarnitines and AF is causal.
Theory and Didactic in Olympiodorus and the Alexandrian School
Authors: Joosse Albert 
Published: October 2020

Abstract
This review article considers two recent Italian and English translations of works by Olympiodorus of Alexandria and his immediate successors (sixth century CE). These translations make accessible to a wider audience a number of works that help us understand a transitional period in the history of thought. This review takes a closer look at some of the substantive views expressed by the translators and evaluates editorial and translation choices. We should beware of exaggerating the differences between these sixth-century philosophers, this review argues, while recognizing that there may be considerable distance between what they thought and what the surviving texts show.
Encounters with the Past
Authors: Giolai Andrea 
Published: October 2020

Abstract
Kasuga Wakamiya Onmatsuri is an important local festival celebrated every winter in Nara. While the festival has been analyzed from the point of view of its relations with religious institutions such as Kasuga Taisha and Kōfukuji, to date less attention has been paid to its historical transformations. Countering linear narratives that tend to portray it as largely unchanged since its inception, this article combines ethnography, historiography, and religious studies to provide a more multivocal analysis of the Onmatsuri. After an overview of its main celebrations, the article revisits the origins of the festival, describes the ontological multiplicity of its deities, and analyzes material elements that concur to its “fractal” features. Showing how these heterogeneous elements generate a diffuse “atmosphere of the past,” this study discusses practitioners’ accounts of ritual participation, as well as the relationship between ideological reconstructions of the past and material embodiments of religious symbols.
Eloquent Plasticity
Authors: Foster Michael Dylan 
Published: October 2020

Abstract
This paper explores Namahage of Akita Prefecture as it assumes three different instantiations: 1) enactment as a private ritual within individual households on New Year’s Eve; 2) performance as a public festival at a shrine in mid-February; and 3) celebration as an “element” inscribed on UNESCO’s Representative List of the Intangible Cultural Heritage of Humanity. I argue that in the first instance, Namahage is part of a vernacular religious “structure of feeling” in which religious elements are inseparable from community life; in the second instantiation, religion is more explicit and codified; and in the third iteration, religion is only vaguely articulated. Tracing the “same” tradition through different forms provides insight into the changing needs of communities and into the dynamics of change itself. With this in mind, I propose a model called hrönirism through which to broadly conceptualize notions of change and difference within traditions such as matsuri.
Sannō Matsuri
Authors: Breen John 
Published: October 2020

Abstract
This study of the Sannō Festival at Hiyoshi Taisha in Shiga Prefecture starts from the premise that all festivals reproduce and reinvent themselves over time, obfuscating their origins, typically claiming specious roots in the ancient or mythical past. Firstly, I analyze the Sannō Festival as performed today, drawing on my own festival fieldwork. I then adopt a historical approach, deploying historical sources to recreate the festival in its premodern guise. Finally, I use an array of primary sources to analyze the contested process of making the modern festival. Throughout, I keep within my purview multiple moving parts: the seven kami and the seven shrines that make up the Hiyoshi Taisha complex; the priests and monks who have venerated them, shaping and reshaping the Sannō Festival; and the common people, too, whose participation is key to the modern festival’s vibrancy and success.
Secret Eroticism and Lived Religion
Authors: Foster Michael Dylan , Ogano Minoru 
Published: October 2020

Abstract
Through interviews and personal observation, this essay introduces the photographer Ogano Minoru, exploring his particular take on the practice of matsuri photography. In his photos, Ogano tries to visually capture the affective aspects of matsuri as experienced by participants. He suggests that even when matsuri are not organized through religious institutions, they emerge from deeply held beliefs and everyday life concerns in the local community. The concluding part of the article is a brief photo essay about mushi-okuri and related matsuri in the Tsugaru region (Aomori Prefecture).
Demographic Change in Contemporary Rural Japan and Its Impact on Ritual Practices
Authors: Klien Susanne 
Published: October 2020

Abstract
Contemporary rural Japan is characterized by depopulation, reflected by the large number of aging residents, abandoned houses and shops (akiya 空家) and an increased number of “hamlets at the margin” (Ono 2005), i.e. hamlets with more than 50 % of residents over 65 years old. As a result, many ritual festivities including matsuri 祭 (festivals) of various kinds face challenges in securing practitioners. This study explores the impact of demographic change on selected ritual practices in Niigata Prefecture, drawing on extensive ethnographic fieldwork conducted in 2007–2009 and 2018. With a focus on the changes that traditional Buddhist dances and Shintō shamanic performing arts known as kagura have undergone as a result of demographic decline and lifestyle shifts, this paper examines the measures residents are taking to ensure the continuity of ritual practices.
Outcomes of Definitive Draining Seton Placement for Complex Anal Fistula in Crohn’s Disease
Authors: Mujukian Angela , Zaghiyan Karen , Banayan Elliot , Fleshner Phillip 
Published: October 2020

Definitive draining seton (DDS) alone is an accepted treatment for complex refractory anal fistulas in Crohn’s disease (CD). We evaluated the long-term success of DDS in CD patients. DDS was defined as draining seton placed definitively for at least 12 months. Primary end point was clinical response (CR) defined as a lack of induration, pain, swelling, abscess recurrence, or unintended dislodgement. The study cohort of 23 patients had a median age of 29 (range; 9-61) years and included 14 males (61%). Reasons for DDS included anal stenosis (n = 9; 39%), active proctitis (n = 9; 39%), and/or anal canal ulceration (n = 9; 39%). Median number of setons was 2 (range; 1-6) and 65% had multiple fistula tracts. Almost all patients (n = 22; 96%) were on a biologic postoperatively. At 12-month follow-up, only 39% (n = 9) had a CR. The remaining 14 patients failed due to new abscess formation (n = 6; 26%), new fistula formation (n = 6; 26%), and seton dislodgement (n = 2; 9%). Six (26%) patients required fecal diversion. No patients required proctectomy. DDS for complex CD fistula results in a mediocre CR with many patients developing recurrent abscess/fistula or requiring diversion despite biologic therapy.
Preablation Diagnostic Whole‐Body Scan vs Empiric Radioactive Iodine Ablation in Differentiated Thyroid Cancer: Cost‐effectiveness Analysis
Authors: Arjani Simran , Quinn Patrick L. , Chokshi Ravi J. 
Published: October 2020

ObjectiveTo perform a comparative analysis of postthyroidectomy radioactive iodine ablation dosing with or without the implementation of a diagnostic whole‐body scan in patients with well‐differentiated thyroid cancer.Study DesignDecision analysis model.SettingHospital or ambulatory center.MethodsA decision tree model was created to determine the cost‐effectiveness of radioactive iodine ablation dosed with diagnostic whole‐body scans versus empiric radioactive iodine ablation in patients with differentiated thyroid cancer undergoing postthyroidectomy ablation. The decision tree was populated with values from the published literature. Costs were represented by 2020 Medicare reimbursement rates (US dollars), and morbidity and survival data were used to calculate quality‐adjusted life‐years. The incremental cost‐effectiveness ratio was the primary outcome.ResultsEmpiric radioactive iodine dosing was the dominant economic strategy, producing 0.94 more quality‐adjusted life‐years while costing $1250.07 less than management with a diagnostic whole‐body scan. Sensitivity analyses upheld these results except in cases involving a large discrepancy in successful ablation rates between the diagnostic and empiric treatment arms.ConclusionFor patients with differentiated thyroid cancer requiring postthyroidectomy ablation, it is more cost‐effective to administer radioactive iodine empirically.
Primary Treatment Selection for Clinically Node‐Negative Merkel Cell Carcinoma of the Head and Neck
Authors: Jacobs Daniel , Olino Kelly , Park Henry S. , Clune James , Cheraghlou Shayan , Girardi Michael , Burtness Barbara , Kluger Harriet , Judson Benjamin L. 
Published: October 2020

ObjectiveMerkel cell carcinoma practice guidelines recommend sentinel lymph node biopsy after wide local excision for the initial management of clinically node‐negative disease without distant metastases (cN0M0). Despite guideline publication, treatment selection remains variable. We hypothesized that receipt of guideline‐recommended care would be more common in patients evaluated at academic centers and institutions with high melanoma case volumes and that such therapy would be associated with improved overall survival.Study DesignRetrospective cohort analysis.SettingThe National Cancer Database from 2004 to 2015.MethodsA total of 3500 patients were included. We utilized Kaplan‐Meier analysis and logistic and Cox proportional hazard regressions. Survival analysis was performed on inverse probability–weighted cohorts.ResultsThere has been a trend toward evaluation at academic programs at a rate of 1.58% of patients per year (95% CI, 1.06%‐2.11%) since 2004. However, the percentage of patients receiving guideline‐compliant primary tumor excision and lymph node evaluation has plateaued at approximately 50% since 2012. Guideline‐compliant surgical management was more commonly provided to patients evaluated at academic programs than nonacademic programs but only when those institutions had a high melanoma case volume (odds ratio, 2.01; 95% CI, 1.62‐2.48). Receipt of guideline‐compliant primary tumor excision and lymph node evaluation was associated with improved overall survival (hazard ratio, 0.70; 95% CI, 0.64‐0.76).ConclusionFacility factors affect rates of receipt of guideline‐compliant initial surgical management for patients with node‐negative Merkel cell carcinoma. Given the survival benefit of such treatment, patients may benefit from care at hospitals with high melanoma case volumes.
Prognostic impact of serum procalcitonin in non-small cell lung cancer
Authors: Kajikawa Shigehisa , Ohashi Wataru , Kato Yasutaka , Fukami Masaya , Yonezawa Toshiyuki , Sato Mika , Kosaka Kenshi , Kato Toshio , Tanaka Hiroyuki , Ito Satoru , Yamaguchi Etsuro , Kubo Akihito 
Published: October 2020

Introduction: Increased serum procalcitonin (PCT), a well-known biomarker for sepsis, has been reported in several cancer types. We aimed to investigate the prognostic impact of PCT in non-small cell lung cancer (NSCLC). Methods: Medical records of 51 consecutive patients with NSCLC (Aichi Medical University Hospital) admitted between July 2017 and July 2018 were retrospectively reviewed. The patients were divided into PCT-low (PCT < 0.1 ng/mL) and PCT-high (PCT ⩾ 0.1 ng/mL) groups, and their clinical characteristics and survival were compared. Results: In contrast to the PCT-low group (n = 24), the PCT-high group (n = 27) showed significantly worse Performance Status (PS) and overall survival (OS) (PS 0–2/3–4, 16/8 versus 12/15, p = 0.034; median OS, not reached versus 127 days, p < 0.001), irrespective of the presence of infection ( p = 0.785). Multivariate analysis showed that the disease stage (IV versus I–III) and high PCT level (⩾0.1 versus <0.1 ng/mL) were significantly worse prognostic factors with hazard ratios of 3.706 ( p = 0.023) and 3.951 ( p = 0.010), respectively. Conclusion: The results suggest that serum PCT in NSCLC was elevated regardless of the presence of infection. Higher PCT levels are associated with poor PS and shorter OS in NSCLC.
Pre-Stroke Depression in Ghana and Nigeria: Prevalence, Predictors and Association With Poststroke Depression
Authors: Ojagbemi Akin , Akinyemi Joshua , Wahab Kolawole , Owolabi Lukman , Arulogun Oyedunni , Akpalu Josephine , Akpalu Albert , Ogbole Godwin , Akinsanya Cynthia , Wasiu Adeniyi , Tito-Ilori Moyinoluwa , Adekunle Fakunle , Lyrea Ruth , Akpa Onoja , Akinyemi Rufus , Sarfo Fred , Owolabi Mayowa , Ovbiagele Bruce 
Published: October 2020

Objectives: Depression is a risk factor for stroke. There is a knowledge gap on the predictors of prestroke depression in stroke survivors living in low- and middle-income countries (LMICs). We estimated prevalence and predictors of prestroke depression, as well as its association with poststroke depression (PSD) in the largest study of stroke in Africa. Methods: We evaluated information collected as part of the Stroke Investigative Research and Education Network (SIREN) study, a multicentre, case-control study conducted at 15 sites in Ghana and Nigeria. Prestroke depression status was ascertained in stroke survivors using a validated self-report tool, while PSD was assessed using a stroke specific screening tool for depression (“HRQOLISP-E”). Independent associations were investigated using complementary log-log regression and binary logit models. Results: Among 1,977 participants, prestroke depression was found in 141 (7.1%). In multivariate analyses, prestroke depression was significantly associated with tachycardia (OR = 2.22, 95% CI = 1.37-3.56) and low consumption of green leafy vegetables (OR = 1.91, 95% CI = 1.12-3.24). Forty-one (29.1%) of the prestroke depression sub-sample developed PSD. However, prestroke depression was not significantly associated with PSD. Conclusion: The findings should energize before-the-stroke identification and prioritization of limited treatment resources in LMICs to persons with depression who have multiple, additional, risks of stroke.
Evaluation of the Incidence and Etiology of Unplanned Return to Operating Room Following Open Reduction Internal Fixation of Distal Radius Fractures
Authors: McEntee Richard M. , Wang William L. , Rondon Alexander J. , Tulipan Jacob E. , Lutsky Kevin F. , Schindelar Lili E. , Matzon Jonas L. , Beredjiklian Pedro K. 
Published: October 2020

Background: Distal radius fractures (DRF) are the most common upper extremity fractures in adults. The purpose of this study was to determine the incidence, causes, and independent predictors for unplanned return to the operating room (URTO) in a single institution within 90 days following distal radius open reduction internal fixation (ORIF). Methods: A retrospective study of 2933 consecutive patients from January 2015 to December 2019 who underwent distal radius ORIF was undertaken. Patients who returned to the operating room within 90 days of the index procedure were identified. Patients with planned return to the operating room for staged procedures were excluded, yielding a patient cohort of those with URTO. Demographic data, causes for reoperation, and final Quick Disabilities of the Arm, Shoulder and Hand DASH (QuickDASH) scores were collected. Results: Overall, 45 patients had URTO (1.5%) occurring a mean of 44 (6-89) days from the index procedure. Reasons for reoperation included nerve complications (n = 14), loss of fixation (n = 11), hardware complications (n = 9), wound complications (n = 7), and tendon complications (n = 4). Neurologic reasons for return included carpal tunnel release (n = 13) and ulnar nerve decompression (n = 1). QuickDASH scores were higher for URTO compared with control cohort at the final follow-up (33 [range: 0-91] vs 14 [range: 0-100], P < .01). Conclusions: Mechanical hardware failure and neurologic symptoms were the most common reasons for URTO after distal fracture ORIF.
Does Undergoing Outpatient Hand Surgery Lead to Prolonged Opioid Use? A Comparison of Surgical and Nonsurgical Patients
Authors: Wang William L. , Lutsky Kevin F. , McEntee Richard M. , Banner Lauren , Katt Brian M. , Nakashian Michael N. , Sodha Samir C. , Rivlin Michael , Beredjiklian Pedro K. 
Published: October 2020

Background: Orthopedic surgical patients in general have been found to be at higher risk for developing opioid dependence in the postoperative period. However, there is conflicting evidence in the literature whether opioid exposure after hand surgery leads to prolonged use. In the absence of a nonoperative control group, it is not clear whether prolonged opioid use in hand surgical patients is related to undergoing a surgical intervention. The purpose of our study to compare opioid prescription fulfillment patterns in surgical and nonoperative patients in a hand surgery practice. Methods: We retrospectively compared 320 patients that underwent elbow, wrist, and hand surgery procedures with 741 nonoperative patients treated by 2 hand surgeons. The Pennsylvania Drug Monitoring Program (PDMP), a mandatory statewide database, was used to evaluate the primary outcomes of filling more than one opioid prescription and filling opioid prescriptions beyond 6 months of the index surgery or clinic visit. Bivariate and multivariable logistic regression analysis was performed using the following variables: surgery, prior benzodiazepine use, and prior opioid use. Results: There was no difference in prior opioid use (15.2% vs 16.9%, P = .51) or prior benzodiazepine (10.4% vs 8.4%, P = .33) use between the nonoperative and operative groups. Patients that underwent surgery had a higher incidence of filling more than one opioid prescription (20.9% vs 8.8%, P < .001). However, continued opioid use was not statistically different between nonoperative and operative patients (2.8% vs 5%, P = .08). Bivariate analysis demonstrated that prior opioids (odds ratio [OR] = 12.94, P < .001) and prior benzodiazepines (OR = 1.95, P < .001) were significant independent risk factors for prolonged opioid use. Multivariable analysis demonstrated prior opioid use to be the only independent risk factor for prolonged opioid use (OR = 12.58, P < .001). Conclusion: Undergoing outpatient hand surgery do not appear to be an independent risk factor for filling opioid prescriptions beyond 6 months. Significant risk factors for prolonged opioid use include prior use of controlled substances, particularly prior opioid use.