Search

The authors used a large clinical data set to determine which index diagnoses of schizophrenia spectrum disorder were new diagnoses.Using the Massachusetts All-Payer Claims Database (2012–2016), the authors identified patients with a schizophrenia spectrum disorder diagnosis in 2016 (index diagnosis) and then reviewed patients’ care histories for the previous 12, 24, 36, and 48 months to identify previous diagnoses. Logistic regression was used to examine patient characteristics associated with the index diagnosis being a new diagnosis.Overall, 7,217 individuals ages 15–35 years had a 2016 diagnosis of schizophrenia spectrum disorder; 67.7% had at least 48 months of historical data. Among those with at least 48 months of care history, 23% had no previous diagnoses. Diagnoses from inpatient psychiatric admissions or among female or younger patients were more likely to represent new diagnoses, compared with diagnoses from most other diagnosis locations or among males or older age groups, and outpatient diagnoses were less likely to represent new diagnoses than were most other diagnosis settings. Reviewing 48 instead of 12 months of data reduced estimated rates of new diagnoses from 112 to 66 per 100,000 persons; historical diagnoses were detected for 61% and 77% of patients with 12 or 48 months of care history, respectively.Examining multiple years of patient history spanning all payers and providers is critical to identifying new schizophrenia spectrum disorder diagnoses in large data sets. Review of 48 months of care history resulted in lower rates of new schizophrenia spectrum disorder diagnoses than previously reported.

In 2020 the COVID-19 pandemic caused millions to lose their jobs and, consequently, their employer-sponsored health insurance. Enacted in 2010, the Affordable Care Act (ACA) created safeguards for such events by expanding Medicaid coverage and establishing Marketplaces through which people could purchase health insurance. Using a novel national data set with information on ACA-compliant individual insurance plans, we found large increases in Marketplace enrollment in 2020 compared with 2019 but with varying percentage increases and spending risk implications across states. States that did not expand Medicaid had enrollment and spending risk increases. States that expanded Medicaid but did not relax 2020 Marketplace enrollment criteria also had spending risk increases. In contrast, states that expanded Medicaid and relaxed 2020 enrollment criteria experienced enrollment increases without spending risk changes. The findings are reassuring with respect to the ability of Marketplaces to buffer employment shocks, but they also provide cautionary signals that risks and premiums could begin to rise either in the absence of Medicaid expansion or when Marketplace enrollment is constrained.

Mobile electrocardiographic (mECG) devices that record ECG lead I have been used to detect atrial fibrillation. Other arrhythmias may not be readily diagnosed with one lead. Obtaining multi‑lead tracings from an mECG (MLmECG) to simulate a 12‑lead ECG may lead to more accurate diagnoses.We developed a method to generate multi‑lead ECGs using a mECG device by attaching it with alligator clips connected to an insulated copper wire to adhesive electrodes on the patient's limbs and torso according to standard lead configurations. Different rhythm and conduction abnormalities from a sample of inpatients were collected. Arrhythmias were recorded in three ways (single lead, MLmECG, and standard 12‑lead) and grouped by category. Recordings were sent to cardiology fellows in the form of a multiple choice survey. Participants were asked for their diagnosis and confidence in their decision.Survey response rate was 100%. Single‑lead, MLmECG, and 12‑lead yielded 48.2%, 81.6%, and 88.6% of agreement with the correct diagnosis, respectively (single‑lead vs. MLmECG or 12‑lead; p0.01). Overall mean confidence scores were 3.34, 4.35, and 4.53 out of 5, for single‑lead, MLmECG, and 12‑lead ECG, respectively (single‑lead vs. MLmECG or 12‑lead; p0.01, MLmECG vs. 12‑lead; p = 0.09).The diagnostic accuracy of MLmECGs were similar to that of a standard 12‑lead ECG. Fellows' confidence in their diagnosis were similar between MLmECG or 12‑lead ECG, and higher with both modalities compared to a single‑lead tracing. The ability to recreate, as fully as possible, a standard 12‑lead ECG is a reasonable goal for mobile technology.

The 2021 American Rescue Plan Act (ARPA) increased the availability and magnitude of premium tax credits (PTCs) for consumers purchasing individual marketplace plans in 2021-2022. Millions currently purchase PTC-ineligible plans off of the marketplace. We estimate the proportion of off-marketplace enrollees who would be eligible for the expanded PTCs under ARPA, calculate PTC amounts for eligible enrollees, and examine factors influencing plan choice that could inform outreach efforts.We analyzed data from a survey of a random sample of off-marketplace enrollees in California in 2017 (n = 829).Using survey data including self-reported income, household size, and employment status combined with 2021 benchmark premium data from Covered California, we estimate eligibility for PTCs and potential PTC amounts under ARPA among off-marketplace enrollees. We adjust for both survey design weights and poststratification weights.Among off-marketplace enrollees, we estimate that approximately 12% are potentially ineligible for PTCs because they reported incomes less than 100% of the poverty level or because they had access to employer-sponsored coverage for their family through themselves or their partner. The median annual PTC in 2021 for eligible off-marketplace enrollees was $311 but varied greatly by age, family or individual plan, and household income (5%-95% range, $0-$14,836). In 2017, 69% of off-marketplace enrollees were unaware that they had to enroll in marketplace plans to receive PTCs, and 51% received enrollment assistance from insurance brokers.These findings suggest the need for targeted outreach to encourage off-marketplace enrollees to switch to marketplace plans.

Radiofrequency catheter ablation is a safe and effective treatment option for atrioventricular nodal reentrant tachycardia (AVNRT). A nonirrigated ablation catheter used in a temperature-controlled mode is traditionally used for AVNRT ablation due to the shallow lesion depth required for successful slow-pathway ablation. In this case, a nonirrigated ablation catheter established inadequate lesions to ablate the slow pathway successfully. The adoption of an irrigated contact-force ablation catheter used in a power-controlled mode was necessary to provide higher power and possibly create a deeper lesion to ablate the slow pathway successfully, thus eliminating AVNRT inducibility in this patient.

Atrioventricular (AV) node-dependent long-R-P tachycardias are a unique group of supraventricular tachycardias that include atypical AV nodal reentrant tachycardia (AVNRT), atypical AVNRT with a concealed bystander nodofascicular (NF)/nodoventricular (NV) accessory pathway inserting into the slow pathway of the AV node, the permanent form of junctional reciprocating tachycardia, and orthodromic NF/NV reciprocating tachycardia. Here, we discuss the complex pathophysiology, diagnosis, and ablation of these intriguing arrhythmias.

In 2020 the COVID-19 pandemic caused millions to lose their jobs and, consequently, their employer-sponsored health insurance. Enacted in 2010, the Affordable Care Act (ACA) created safeguards for such events by expanding Medicaid coverage and establishing Marketplaces through which people could purchase health insurance. Using a novel national data set with information on ACA-compliant individual insurance plans, we found large increases in Marketplace enrollment in 2020 compared with 2019 but with varying percentage increases and spending risk implications across states. States that did not expand Medicaid had enrollment and spending risk increases. States that expanded Medicaid but did not relax 2020 Marketplace enrollment criteria also had spending risk increases. In contrast, states that expanded Medicaid and relaxed 2020 enrollment criteria experienced enrollment increases without spending risk changes. The findings are reassuring with respect to the ability of Marketplaces to buffer employment shocks, but they also provide cautionary signals that risks and premiums could begin to rise either in the absence of Medicaid expansion or when Marketplace enrollment is constrained.

Kurzfassung Die Entwicklung Kunstlicher Intelligenzen (KI) setzt Kooperation und grose Datenmengen voraus. Viele Anwendungen „schwacher KI“ funktionieren bereits, auch die nur abstrakt begreifbare ...

BACKGROUND Mobile electrocardiograms (mECGs) utilizing smartphone applications are an emerging technology. Typically, a Lead I rhythm strip is recorded. However, interpretation can be difficult in patients with sinus rhythm and low amplitude P-waves (SR-LAP) or atrial flutter (AFL). We hypothesized that patients could independently obtain multi-lead tracings using a commercial mECG device, and that cardiologists who interpreted the multi-lead tracings would make more accurate diagnoses and have more confidence in their interpretation compared to a single lead only. METHODS Thirty sets of recordings were obtained from 10 patients with either SR-LAP or AFL that was not apparent on Lead I on a standard ECG. Patients recorded Lead I, Lead II, and Lead V1 tracings using AliveCor's KardiaMobile mECG device. Twenty-nine cardiologists reviewed each patient's Lead I tracing, multi-lead tracings (Leads I, II, V1), and 12-lead ECG. Accuracy was noted and each cardiologist rated their level of confidence in their interpretation. RESULTS All patients were able to record their own single and multi-lead tracings. Single lead, multi-lead, and the 12-lead ECG yielded 36.4%, 84.3%, and 97.7% agreement with the established diagnosis, respectively (P

Actomyosin networks, the cell’s major force production machineries, remodel cellular membranes during myriad dynamic processes(1,2) by assembling into various architectures with distinct force generation properties(3,4). While linear and branched actomyosin architectures are well characterized in cell-culture and cell-free systems(3), it is not known how actin and myosin networks form and function to remodel membranes in complex three-dimensional mammalian tissues. Here, we use four-dimensional spinning-disc confocal microscopy with image deconvolution to acquire macromolecular-scale detail of dynamic actomyosin networks in exocrine glands of live mice. We address how actin and myosin organize around large membrane-bound secretory vesicles and generate the forces required to complete exocytosis(5–7). We find that actin and non-muscle myosin II (NMII) assemble into previously undescribed polyhedral-like lattices around the vesicle membrane. The NMII lattice comprises bipolar minifilaments(8–10) as well as non-canonical three-legged configurations. Using photobleaching and pharmacological perturbations in vivo, we show that actomyosin contractility and actin polymerization together push on the underlying vesicle membrane to overcome the energy barrier and complete exocytosis(7). Our imaging approach thus unveils a force-generating actomyosin lattice that regulates secretion in the exocrine organs of live animals.

This paper reframes the intellectual genealogy of Baʿthism in modern Syria through a close reading of the writings of one of its founding figures, Michel ʿAflaq. Rereading ʿAflaq's most important texts is part of a broader reconsideration of the intellectual history of modern Syria between nationalism and liberalism, revolution and reaction. While recognizing the traces of nineteenth-century German idealist philosophy and Romantic nationalism in ʿAflaq's thought, this piece complicates the conventional understanding of his work by showing a striking resemblance with the left-personalism of Emmanuel Mounier and theEspritgroup. This unexplored connection constitutes a “missing link” in the intellectual genealogy of Baʿthism. As such, this article contributes to a more expansive and complicated global history of personalism. At the same time, this reconsideration of Michel ʿAflaq suggests a more compelling account of the making of modern Syria, a history with roots more tangled than historians have hitherto imagined.

BACKGROUND/OBJECTIVES: No data exist regarding the validity of International Classification of Disease (ICD)-10 dementia diagnoses against a clinician-adjudicated reference standard within Medicare claims data. We examined the accuracy of claims-based diagnoses with respect to expert clinician adjudication using a novel database with individual-level linkages between electronic health record (EHR) and claims. DESIGN: In this retrospective observational study, two neurologists and two psychiatrists performed a standardized review of patients’ medical records from January-2016 to December-2018, and adjudicated dementia status. We measured the accuracy of three claims-based definitions of dementia against the reference standard. SETTING: Mass-General-Brigham Healthcare (MGB), Massachusetts, USA. PARTICIPANTS: From an eligible population of 40,690 fee-for-service (FFS) Medicare beneficiaries, aged 65-years and older, within the MGB Accountable Care Organization (ACO), we generated a random sample of 1,002 patients, stratified by the pretest likelihood of dementia using administrative surrogates. INTERVENTION: None. MEASUREMENTS: We evaluated the accuracy (area-under-receiver-operating-curve [AUROC]) and calibration (calibration-in-the-large [CITL] and calibration slope) of three ICD-10 claims-based definitions of dementia against clinician-adjudicated standards. We applied inverse probability weighting to reconstruct the eligible population and reported the mean and 95% confidence interval (95% CI) for all performance characteristics, using 10-fold cross-validation (CV). RESULTS: Beneficiaries had an average age of 75.3-years and were predominately female (59%) and non-Hispanic white (93%). The adjudicated prevalence of dementia in the eligible population was 7%. The best performing definition demonstrated excellent accuracy (CV-AUC 0.94; 95% CI 0.92-0.96) and was well-calibrated to the reference standard of clinician-adjudicated dementia (CV-CITL

Background: The ACC/AHA currently recommend performing a 14-point cardiovascular (CV) evaluation when screening healthy student-athletes for CV disease. This includes a focused history to assess for cardiac symptoms including exertional chest pain, dyspnea, fatigue, palpitations, and syncope. Though the presence of these symptoms may suggest underlying CV disease, additional factors including hours of weekly physical activity may influence the prevalence of reported symptoms. The relationship between physical activity level and the prevalence of cardiac symptoms has not been fully studied in an adolescent population. Methods: We analyzed the results of 10683 consecutive athlete screenings (median age 15 years) from HeartBytes, a data registry of pre-participation youth CV screenings utilizing the 14-point AHA evaluation. Cardiac symptoms and hours of weekly physical activity were self-reported. Weekly activity level was reported as less than 2 hours, between 2 and 5 hours, between 5 and 10 hours, or as greater than 10 hours. A chi-squared analysis for independence was performed to evaluate the relationship between physical activity level and each cardiac symptom. Results: Chest pain was reported in 5.1% of athletes, and increasing hours of physical activity was associated with less reported pain ( X 2 = 73.01, p X 2 = 120.53, p X 2 = 376.61, p X 2 = 95.34, p X 2 = 5.53, p = 0.24). Conclusion: Increased physical activity is associated with lower rates of reported chest pain, exertional dyspnea, easy fatigability, and palpitations in adolescents. Further studies are needed to clarify the relationship in youth athletes between symptoms and CV health.

In the fossil-rich sediments of the Megalopolis Basin, southern Greece, the remains of an ancient paleo-lake alternate between detrital units and lignite seams deposited during the Middle Pleistocene. The detrital sediments of MAR-1 (480-420 kyr) between two lignite seams are where lithics and elephant bones with cut-marks have been systematically excavated indicating hominin activity along a paleo-shoreline circa 440 kyr. Based on current knowledge, lignite seams formed during interglacials, while the silty-clay-rich deposits in between were deposited under glacial conditions. However, the paleoenvironmental and paleoclimatic conditions on shorter times-scales, leading to the preservation of hominin activity in the area, remain largely unknown. In order to reconstruct the paleo-environment including paleo-lake levels and thus sedimentation patterns and their governing paleo-climatic factors, we analyzed a high resolution 5-meter long sediment sequence from the archaeological site MAR-1. For the reconstruction, a multiproxy approach was applied using microfossils, grain-size, and geochemical analysis such as total organic carbon, total inorganic carbon, X-ray diffraction, and conventional X-ray fluorescence. Diatoms were often too corroded to be of use, most likely due to a combination of alkaline water conditions and the influence of silicate sponges. The results of the analyses revealed that MAR-1, located between lignite unit II and III, experienced multiple lake level oscillations mostly following insolation changes suggesting that several short-term wet-dry-wet cycles occurred during the investigated period, which must have impacted flora and fauna, including hominins, in the area. This research was conducted under the auspices of the Ephoreia of Paleoanthropology and Speleology, Greek Ministry of Culture, and was supported by the European Research Council (PaGE, CROSSROADS).

α- d -pentofuranose-1-phosphates (Pentose-1Ps) are key intermediates in nucleoside metabolism and important precursors for the enzymatic synthesis of modified nucleosides. To date, Pentose-1Ps are mainly produced by chemical approaches which have numerous disadvantages. Therefore, several enzymatic methods employing mesophilic enzymes have been developed but are not widely applied due to their limited substrate spectrum. Here we report the use of thermostable nucleoside phosphorylases for the chemo-enzymatic synthesis of modified Pentose-1Ps (2-deoxy-2-fluoro-α- d -ribofuranose-1-phosphate, α- d -arabinofuranose-1-phosphate, and 2-deoxy-2-fluoro-α- d -arabinofuranose-1-phosphate), which are interesting building blocks for the synthesis of modified nucleosides. After optimizing the synthesis protocol using the natural substrates uridine and thymidine, grams of modified Pentose-1Ps were purified as their Ba-salts with over 95% purity. Their structures were confirmed by NMR spectroscopy and the temperature and pH stability of natural and modified Pentose-1Ps in aqueous solution was -evaluated. Four of the Pentose-1P-Ba salts were stable with no visible degradation up to 60 °C and pH above 5, while 2-deoxy-α- d -ribofuranose-1-phosphate was less stable. The presented protocol provides an easy, fast, and environmentally-friendly method to produce grams of modified Pentose-1P-Ba salts of high purity.

Contemporary Syrian literature bears unmistakable traces of more than four decades of authoritarian rule. This article identifies connections among aesthetics, politics, and affect in two Syrian novels, Rūzā Yāsīn Ḥasan’s Brūfā (Rough Draft) (2011) and Samar Yazbik’s Lahā marāyā (In Her Mirrors) (2010). Through literary representations of state security (the mukhābarāt), surveillance—including the structure and function of mirrors and screens, eavesdropping, and security stations—and new conceptions of the political, state power influences cultural production, even as the contemporary Syrian novel offers a critique of authoritarian dictatorship’s immanent relationship to the practice of narration itself.

Background Screening electrocardiography (ECG) for athletes is both controversial and rapidly evolving. While identifying an abnormal ECG could detect a serious cardiovascular disease, falsely interpreting a benign ECG pattern as abnormal can lead to unnecessary testing, cost, and anxiety. Though recent refinements of athlete screening ECG criteria have significantly improved its accuracy, in clinical practice physician adherence to these criteria may vary. Methods We analyzed physician adherence to contemporary athlete ECG criteria in a large, national athlete screening registry. 1577 consecutive screening ECGs were independently re- interpreted to assess for physician adherence to Seattle Criteria or International Criteria, respective to the criteria in place when the screening was performed. We further determined the most common ECG interpretations that deviated from these criteria, and analyzed physician characteristics for independent predictors of adherence to published ECG criteria. Results Though overall adherence to contemporary criteria was high, 60.4% of ECGs interpreted as abnormal did not meet athlete ECG criteria for pathology when independently re- read. The most common ECG patterns misinterpreted as abnormal were isolated left ventricular hypertrophy (LVH) and non-pathologic T-wave inversions (TWI). Multivariate regression identified three independent predictors of adherence to athlete ECG criteria: participating in a screening overseen by the organization's medical leadership, electrophysiology specialists and adult cardiologists. Conclusion This study highlights the need for quality control measures and continued clinician education in a controversial and rapidly evolving field. Clinician education for athlete screening ECG criteria should emphasize the recent changes in how TWI and LVH voltage criteria should be interpreted in this patient population.

For decades, scholars and public intellectuals have been predicting the demise of religion in the face of secularization. Yet religion is undergoing an unprecedented resurgence in modern life—and secularization no longer appears so inevitable. This book brings together many of today's leading historians to shed critical light on secularism's origins, its present crisis, and whether it is as antithetical to religion as it is so often made out to be. The book offers a more nuanced understanding of the origins of secularist thought, demonstrating how Reformed Christianity and the Enlightenment were not the sole vessels of a worldview based on rationalism and individual autonomy. Taking readers from late antiquity to the contemporary era, the chapters show how secularism itself can be a form of belief and yet how its crisis today has been brought on by its apparent incapacity to satisfy people's spiritual needs. The book explores the rise of the humanistic study of religion in Europe, Jewish messianism, atheism and last rites in the Soviet Union, the cult of the saints in colonial Mexico, religious minorities and Islamic identity in Pakistan, the neuroscience of religion, and more.

This chapter explores the experience of two contemporary Middle Eastern thinkers: Sadiq Jalal al-ʻAzm and Nasir Hamid Abu Zayd. The former, writing in the aftermath of the Arab–Israeli War of 1967, penned a critique of Islam, alleging that its blinkered repressiveness had set the Arab world up for defeat. The latter, writing in the 1990s, sought to fashion a modern, enlightened Islam and, in pursuit of that end, subjected Islam's most sacred text, the Qur'an, to critical philological scrutiny. Both men paid a price for their heterodoxy: al-ʻAzm lost his job at the American University in Beirut and was tried for incitement of religious discord; Abu Zayd was denied promotion at Cairo University and also subjected to public prosecution. The interest in the present context is that in both instances the prosecuting agency was the so-called secular state, whether Lebanese or Egyptian, and it acted in response to the prodding of mobilized religious constituencies, thus transforming itself, though secular, into an accomplice of sectarianism. Postcolonial Arab nationalisms, as had Soviet communism before them, held out the promise of liberation, but liberation, once again, turned out to be a mixed blessing. The secular state did not set itself up in opposition to faith but catered to believers, enhancing its own power by giving satisfaction to the repressive impulses of religious orthodoxy.

When and how do politicians talk about public health crises? Using evidence from the opioid crisis in the United States, this paper assembles and analyzes novel data on Congressional statements to explore the conditions under which politicians (1) issue public statements about opioids and (2) frame the opioid crisis as a predominantly public health or law enforcement problem. We examined 3.8 million Congressional floor speeches and 111,000 public statements to identify (1) floor speeches about drug crises in the 97th to 114th Congresses (1981-2017) and (2) public statements about the opioid crisis in the 116th Congress (2019-2020). Moderate ideology, women, greater overdose deaths, and larger white populations are associated with significantly higher frequencies of opioid statements. Using a dictionary-based text analysis approach, we find that ideologically liberal and African American legislators are more likely to use public health framing, while ideologically conservative members are more likely to use law enforcement framing and refer to national borders or foreign countries in opioid statements. Democrats/liberals more often referenced medication treatment for opioids. These findings imply two broader conclusions about the nature of political discourse in public health crises. First, that political extremists are least likely to talk about opioids suggests that increasing partisan polarization may result in less discussion, emphasis, and expertise in public health issues. Second, the tenor of discourse about opioids and other public health crises is likely to change with partisan electoral waves, potentially hindering long term planning of public health capacity.

Systemic therapy of adrenocortical carcinoma (ACC) is limited by heterogeneous tumor response and adverse effects. Recently, we demonstrated anti-tumor activity of LEDP-M (etoposide, liposomal doxorubicin, liposomal cisplatin, mitotane), a liposomal variant of EDP-M (etoposide, doxorubicin, cisplatin, mitotane). To improve the therapeutic efficacy and off-target profiles of the clinical gold standard EDP-M, we investigated liposomal EDP-M regimens in different preclinical settings and in a small number of ACC patients with very advanced disease. Short- and long-term experiments were performed on two ACC models (SW-13 and SJ-ACC3) in vivo. We evaluated the anti-tumoral effects and off-target profiles of EDP-M, LEDP-M and a novel regimen L(l)EDP-M including liposomal etoposide. Furthermore, the role of plasma microRNA-210 as a therapeutic biomarker and first clinical data were assessed. Classical and liposomal protocols revealed anti-proliferative efficacy against SW-13 (EDP-M P P P P P P P P P = 0.003) compared to L(l)EDP-M treatment. Raising its potential for therapy monitoring, we detected elevated levels of circulating microRNA-210 in SW-13 after LEDP-M treatment (P

A case of a 71-year-old female patient with osteochondrosis dissecans of the right temporomandibular joint is presented. Osteochondrosis dissecans usually occurs at the weight-bearing convex cartilage in all larger joints. It is rarely found in the temporomandibular joint and usually shows one or two loose bodies dislodged from defects which are present on the condylar head. Because of multiple loose bodies and a defect on the temporomandibular fossa, the case presented here is very uncommon.