Search

The Super-Kamiokande detector can be used to search for neutrinos in time coincidence with gravitational waves detected by the LIGO-Virgo Collaboration (LVC). Both low-energy ($7-100$ MeV) and high-energy ($0.1-10^5$ GeV) samples were analyzed in order to cover a very wide neutrino spectrum. Follow-ups of 36 (out of 39) gravitational waves reported in the GWTC-2 catalog were examined; no significant excess above the background was observed, with 10 (24) observed neutrinos compared with 4.8 (25.0) expected events in the high-energy (low-energy) samples. A statistical approach was used to compute the significance of potential coincidences. For each observation, p-values were estimated using neutrino direction and LVC sky map ; the most significant event (GW190602_175927) is associated with a post-trial p-value of $7.8\%$ ($1.4\sigma$). Additionally, flux limits were computed independently for each sample and by combining the samples. The energy emitted as neutrinos by the identified gravitational wave sources was constrained, both for given flavors and for all-flavors assuming equipartition between the different flavors, independently for each trigger and by combining sources of the same nature., Comment: 16 pages, 5 figures. v2: adding corrections from The Astrophysical Journal review

Background To investigate the efficacy of secukinumab in patients with active non-radiographic axial spondyloarthritis (nr-axSpA) grouped by disease activity as assessed by C-reactive protein (CRP) levels and/or magnetic resonance imaging (MRI) scores, human leukocyte antigen (HLA)-B27 status, and sex. Methods The phase III PREVENT study randomized (1:1:1) 555 patients to receive subcutaneous secukinumab 150 mg with (LD) or without (NL) loading dose or placebo weekly, followed by every 4 weeks starting at week 4. Here, we report the results of a post hoc analysis reporting the efficacy outcomes (pooled secukinumab) to 16 weeks by CRP, MRI, HLA-B27, and sex. Results Efficacy differences between the secukinumab and the placebo groups were highest in the CRP+, MRI+, HLA-B27+, and male subgroups, particularly for Ankylosing Spondylitis Disease Activity Score-CRP inactive disease and Assessment of SpondyloArthritis international Society (ASAS) partial remission outcomes. ASAS40 response rates in the CRP+/MRI+ subgroup was 52.3% (secukinumab) versus 21.8% (placebo; P < 0.0001) at week 16. ASAS40 response rates (secukinumab versus placebo) were 43.9% versus 32.6% in HLA-B27+, 32.7% versus 16.4% in HLA-B27− subgroups, 51.2% versus 30.8% in male, and 31.7% versus 25.3% in female patients, respectively. Conclusions Secukinumab improved the signs and symptoms of nr-axSpA across patients grouped by CRP (+/−) and/or MRI (+/−) status, HLA-B27 (+/−) status, and sex. The highest treatment differences between secukinumab and placebo were observed in patients with both elevated CRP and evidence of sacroiliitis on MRI. Treatment difference was minimal between HLA-B27 (+) and (−) subgroups. Male patients had higher relative responses than female patients. Trial registration ClinicalTrials.gov, NCT02696031. Registered on 02 March 2016

The radioactivity background are among the most dangerous background for low energy neutrino analysis in Super-Kamiokande (SK), like the solar neutrino analysis. Among them, the main contribution is coming from $^{222}$Rn, which is spread in the detector's water due to the water source and to the photo multiplier (PMT) emanations. Up to now, its exact distribution in the detector was not known. Using our knowledge of the radon concentration in the detector water, and the SK-IV solar data, we developed a model of the radon distribution in the detector. The uncertainty on the Rn concentration associated with this model was estimated to be $\sim0.1$ mBq/m$^{3}$

Issue: Life-long learning is a skill that is central to competent health professionals, and medical educators have sought to understand how adult professionals learn, adapt to new information, and independently seek to learn more. Accrediting bodies now mandate that training programs teach in ways that promote self-directed learning (SDL) but do not provide adequate guidance on how to address this requirement. Evidence: The model for the SDL mandate in physician training is based mostly on early childhood and secondary education evidence and literature, and may not capture the unique environment of medical training and clinical education. Furthermore, there is uncertainty about how medical schools and postgraduate training programs should implement and evaluate SDL educational interventions. The Shapiro Institute for Education and Research, in conjunction with the Association of American Medical Colleges, convened teams from eight medical schools from North America to address the challenge of defining, implementing, and evaluating SDL and the structures needed to nurture and support its development in health professional training. Implications: In this commentary, the authors describe SDL in Medical Education, (SDL-ME), which is a construct of learning and pedagogy specific to medical students and physicians in training. SDL-ME builds on the foundations of SDL and self-regulated learning theory, but is specifically contextualized for the unique responsibilities of physicians to patients, inter-professional teams, and society. Through consensus, the authors offer suggestions for training programs to teach and evaluate SDL-ME. To teach self-directed learning requires placing the construct in the context of patient care and of an obligation to society at large. The SDL-ME construct builds upon SDL and SRL frameworks and suggests SDL as foundational to health professional identity formation.KEYWORDSself-directed learning; graduate medical education; undergraduate medical education; theoretical frameworksSupplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1938074 .

This is the fourth Active Healthy Kids (AHK) Wales Report Card. The 2021 card produced grades on children and young people’s physical activity (PA) using pre-COVID-19 data that were not used in previous versions. Eleven quality indicators of PA were graded through expert consensus and synthesis of the best available evidence. Grades were assigned as follows: Overall PA—F; Organised Sport and PA—C; Active Play—C+; Active Transportation—C−; Sedentary Behaviours—F; Physical Fitness—C−; Family and Peer Influences—D+; School—B−; Community and the Built Environment—C; National Government and Policy—C; and Physical Literacy—C−. All but three grades remained the same or decreased from the 2018 AHK-Wales Report Card (Active Play increased from C− to C+; Active Transportation, D+ to C−; Family and Peers, D to D+). This is concerning for children’s health and well-being in Wales, particularly given recent evidence that PA has further decreased during the COVID-19 pandemic. The results from the Report Card should be used to inform the decision making of policy makers, practitioners and educators to improve children and young people’s PA levels and opportunities and decrease PA inequalities.

Virtual meeting platforms, such as Zoom, have become essential to medical education during the SARS-CoV-2 pandemic. However, many medical educators do not have experience planning or leading these sessions. Despite the prevalence of Zoom learning, there has been little published on best practices. In this article we describe best practices for using Zoom for remote learning, acknowledging technical considerations, and recommending workflows for designing and implementing virtual sessions. Furthermore, we discuss the important role of cognitive learning theory and how to incorporate these key pedagogical insights into a successful virtual session. While eventually in-person classrooms will open, virtual teaching will remain a component of medical education. If we utilize these inventive tools creatively and functionally, then virtual learning can augment and elevate the practice of medical education.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), a respiratory illness that can result in hospitalization or death. We used exome sequence data to investigate associations between rare genetic variants and seven COVID-19 outcomes in 586,157 individuals, including 20,952 with COVID-19. After accounting for multiple testing, we did not identify any clear associations with rare variants either exome wide or when specifically focusing on (1) 13 interferon pathway genes in which rare deleterious variants have been reported in individuals with severe COVID-19, (2) 281 genes located in susceptibility loci identified by the COVID-19 Host Genetics Initiative, or (3) 32 additional genes of immunologic relevance and/or therapeutic potential. Our analyses indicate there are no significant associations with rare protein-coding variants with detectable effect sizes at our current sample sizes. Analyses will be updated as additional data become available, and results are publicly available through the Regeneron Genetics Center COVID-19 Results Browser.

We revisit the system consisting of a neutron star that harbors a small, possibly primordial, black hole at its center, focusing on a nonspinning black hole embedded in a nonrotating neutron star. Extending earlier treatments, we provide an analytical treatment describing the rate of secular accretion of the neutron star matter onto the black hole, adopting the relativistic Bondi accretion formalism for stiff equations of state that we presented elsewhere. We use these accretion rates to sketch the evolution of the system analytically until the neutron star is completely consumed. We also perform numerical simulations in full general relativity for black holes with masses up to nine orders of magnitude smaller than the neutron star mass, including a simulation of the entire evolution through collapse for the largest black hole mass. We construct relativistic initial data for these simulations by generalizing the black hole puncture method to allow for the presence of matter, and evolve these data with a code that is optimally designed to resolve the vastly different length scales present in this problem. We compare our analytic and numerical results, and provide expressions for the lifetime of neutron stars harboring such endoparasitic black holes., 20 pages, 9 figures; version published in PRD

Background: Little is known about historical and recent application trends for pulmonary critical care medicine (PCCM) or pulmonary medicine (PM) fellowship programs. Describing trends in and characteristics of PCCM and PM applications, applicants, and fellowship programs can help program directors and medical educators understand trainees’ interest in and application patterns for these fellowship programs. Objective: The objective of this study was to use National Residency Match Program data to assess recent trends in PCCM and PM fellowship applications and compare characteristics of applicants and fellowship programs. Methods: In 2019, we used National Residency Match Program data to evaluate applicant ranking and matching in PCCM and PM fellowship programs and to compare applicant and fellowship program characteristics. Results: From 2008 through 2019, the majority of applicants (59.1%) matched into PCCM were graduates of U.S. allopathic or osteopathic medical schools, whereas 87% of PM fellows were non-U.S. graduates. PCCM was the preferred specialty for 90.8% of matched applicants versus only 31.6% of matched PM applicants (P

Lens-less millimeter-wave (mmWave) imaging of moving objects using a sparse array relies on knowledge of the relative positions between the moving object and the imaging system to enable coherent image reconstruction. However, accurate object position information is rarely available in commercial applications where the moving object, e.g. a conveyor belt or a robot, is controlled independently of the imaging system, or where the imaged objects move autonomously. This poses a significant hurdle for many commercial mmWave imaging applications. We present a video-based motion extraction approach for active mmWave imaging. The object velocity is extracted in real time from motion vectors obtained from a compressed video. This information is combined with readouts from a distance sensor to infer the position of the object at each time instant. Leveraging video-derived motion vectors enables the offloading of computational complexity of 2-D spatial correlations to highly optimized algorithms operating on camera frames. We show experimentally that the image quality of a commercial high-throughput 3-D mmWave imaging system prototype is improved significantly by this approach when the velocity of the target is unknown and time-varying. We furthermore show that image quality is also improved compared to known average motion profiles of the imaged objects. Using a lab setup with known ground truth, we show that the RMS position error is 2.5 mm over a travel length of 0.52 m. This is better than 1/8 of the wavelength at K-band (24 GHz) along the trajectory and thus sufficient to achieve excellent image quality at K-band and longer wavelengths.

Purpose— National screening estimates mask county-level variations. We aimed to generate county-level colorectal cancer (CRC) screening prevalence estimates for 2018 among adults aged 50-75 years and identify counties with low screening prevalence. Methods— We combined individual-level county data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) (n=204,947) with the 2018 American Community Survey county poverty data as a covariate, and the 2018 U.S. Census county population count data to generate county-level prevalence estimates for being current with any CRC screening test, colonoscopy, and home stool blood test. Because BRFSS is a state-based survey, and because some counties did not have samples for analysis, we used correlation coefficients to test internal consistency between model-based and BRFSS state estimates. Results— Correlation coefficients tests were ≥0.97. Model-based national prevalence for any test was 69.9% (95% CI, 69.5%-70.4%) suggesting 30% are not current with screening test use. State mean estimates ranged from 62.1% in Alaska and Wyoming to 76.6% in Maine and Massachusetts. County mean estimates ranged from 42.2% in Alaska to 80.0% in Florida and Rhode Island. Most tests were performed with colonoscopy. Conclusions— Estimates across all U.S. counties showed large variations. Estimates may be informative for planning by states and local screening programs.

Rationale: Clinical and research training opportunities in global health are of increasing interest to medical trainees, but little is known about such opportunities in U.S.-based pulmonary and pulmonary/critical care medicine (PCCM) fellowship programs. Objectives: Summarize currently available global health–related training opportunities and identify potential barriers to implementing global health curricula among U.S.-based PCCM fellowship programs. Methods: We sent a confidential, online, targeted needs assessment to PCCM fellowship program directors and associate program directors. Data collected included program demographics, currently available global health–related clinical and research training opportunities, potential barriers to the implementation of global health–related programmatic content, and perceived interest in global health–related training opportunities by current and/or prospective trainees. To evaluate for nonresponse bias, we performed an online search to identify global health–related training opportunities offered by nonresponding programs. Results: Out of 171 surveyed programs, 63 PCCM fellowship programs (37%) provided survey responses. Most responses (n = 56, 89%) were from combined PCCM training programs; 66% (n = 40) of programs offered at least one component of global health–related clinical or research training. Overall, 27% (n = 17) had a Ruth L. Kirschstein National Research Service Award Institutional Research Training Grant (National Institutes of Health T32), 73% (n = 46) had fewer than 35 faculty members, and 51% (n = 32) had at least one faculty member conducting global health–focused research. Most responding programs (66%, n = 40) offered at least one global health–related educational component. Among programs that would like to offer global health–related training components, the most common barriers included competing priorities for lecture content and a lack of in-division mentors with global health experience, a champion for global health–related activities, and established partnerships outside the United States. Conclusions: PCCM program leaders are interested in offering global health–related training opportunities, but important barriers include lack of mentorship, dedicated fellowship time, and established global partnerships. Future research is needed to better understand global health–related interests and training needs of incoming fellows and to design creative solutions for providing global health–related training across academic institutions with variable global health–related training capacities.

There is an art in “making do.” Making do is a vernacular phrase heard frequently in the Southeast United States, especially in lower socioeconomic households. It means “making ends meet” when money is tight by using the resources on hand. We investigate the design of making do by small businesses in such contexts by analyzing their business signage. A trained designer may pass by these “mom and pop” shops and find the signage to be merely novel, but we find that there is much more to learn. We complete a case series analysis of mom and pop signage using in-depth methods, including autoethnographic accounts of each author’s lived experience with mom and pop signageand a subsequent content analysis using visual grounded theory methods in a highly reflexive approach. We discover three main themes in play: “radical resourcefulness,” “authenticity/humanity,” and the “amateur aesthetic.” Radical resourcefulness is a dramatic shift in use and reuse of materials. A design may be considered “authentic” or have a visible connection to “humanity” when viewers can see evidence of the human hand or human decision-making in the design artifact. Amateur aesthetic, is a term applied to untrained "designers" who transform readily available materials to achieve their design goals. Each of these themes is especially relevant to disciplines such as communications and marketing, illuminating possibilities of community partnership and collaboration. At the same time, approaching the significance of mom and pop signage in this way provides insights for the professional design discipline as a whole, presenting opportunities for new interdisciplinary research, teaching, and service.

More than a decade has passed since the finalization of the Human Genome Project. Omics technologies made a huge leap from trendy and very expensive to routinely executed and relatively cheap assays. Simultaneously, we understood that omics is not a panacea for every problem in the area of human health and personalized medicine. Whilst in some areas of research omics showed immediate results, in other fields, including asthma, it only allowed us to identify the incredibly complicated molecular processes. Along with their possibilities, omics technologies also bring many issues connected to sample collection, analyses and interpretation. It is often impossible to separate the intrinsic imperfection of omics from asthma heterogeneity. Still, many insights and directions from applied omics were acquired-presumable phenotypic clusters of patients, plausible biomarkers and potential pathways involved. Omics technologies develop rapidly, bringing improvements also to asthma research. These improvements, together with our growing understanding of asthma subphenotypes and underlying cellular processes, will likely play a role in asthma management strategies.

In the United States, physicians finishing residency or fellowship training or who are at different stages of their careers frequently take academic positions in medical centers in different states. Despite the frequency with which students move among states, there is a paucity of guidance in the literature regarding best practices for minimizing the disruptions and challenges associated with moving to a new position in a new state. In this article, we review the available peer-reviewed and non-peer-reviewed literature to provide specific guidance for physicians and healthcare professionals transitioning to a new position in a different state., Moving from one state to another for a new position or opportunity is a common event for academic physicians. Although moving can be personally and professionally disruptive for everyone, it can be particularly challenging for academic physicians. From practical considerations such as applying for a new state medical license to professional challenges such as minimizing disruption to educational or research projects, there are numerous challenges associated with relocating to an academic institution in a new state. Despite the frequency with which academic physicians move between institutions in different states, we could not identify any practical guidance about moving in the literature. We searched the peer-reviewed literature, reviewed non-peer-reviewed open access sources, and drew from our own experience as academic physicians who have recently moved, and collated pertinent resources to develop a guide of what physicians need to consider when planning a move to a new position in a new state. Our review and guidance considers the following issues: state licensing, governmental certification, maintaining communication with collaborators and colleagues, working with institutional review boards regarding ongoing research projects, transferring funds from grants, transitioning out of clinical practice, and transferring data and resources. Anticipating the requirements and challenges of moving can help academic physicians, whether at the beginning, middle, or end of their careers, with the process of moving to a new state for a new position.

The current and projected deficit in the physician workforce in the US is a challenge for primary care and specialty medical settings. Foreign medical graduates (FMGs) represent an important component of the US graduate medical education (GME) training pathway and can help to address the US physician workforce deficit. Availability of FMGs is particularly important to the internal medicine community, as recent data demonstrate that internal medicine is the specialty with the highest number of FMGs. System-based and logistical inefficiencies in the current US visa system represent significant obstacles to FMG trainees and have important psychological, emotional, and logistical consequences to FMG engagement and participation in US GME training and in the post-training workforce. In this article, we review the contemporary structure, process, and challenges of obtaining a visa for GME training. The H1B and J1 visa programs are compared and contrasted, with an emphasis on logistical specifics for FMG GME trainees and training programs. The process of and options for J1 visa waivers are reviewed. These considerations are specifically reviewed in the context of recent policy decisions by the Trump administration, with emphasis on the effects of these decisions on FMGs in medical training and practice.

Live discussions on the social media site Twitter or Twitter chats are gaining popularity as powerful tools for engaging a broad audience in an interactive discussion. Medical education, in particular, is experiencing an increase in the use of this modality to support informal learning, as a means to encourage collaboration and share best practices, and as a platform for large-scale mentorship. Despite this growth in popularity, there are limited data to guide medical educators on the fundamentals of organizing a Twitter chat. In this Twelve Tips article, we discuss strategies relevant to potential Twitter chat organizers. We have arranged the tips chronologically, beginning with a discussion of initial considerations when planning and formulating a chat topic and publicizing the chat to potentially interested people and groups, followed by practical considerations while hosting the chat, and finally strategies for evaluating and extending a Twitter chat's impact.

Two key moments shaped the extant South Asian gene pool within the last 10 thousand years (ka): the Neolithic period, with the advent of agriculture and the rise of the Harappan/Indus Valley Civilisation; and Late Bronze Age events that witnessed the abrupt fall of the Harappan Civilisation and the arrival of Indo-European speakers. This study focuses on the phylogeographic patterns of mitochondrial haplogroups H2 and H13 in the Indian Subcontinent and incorporates evidence from recently released ancient genomes from Central and South Asia. It found signals of Neolithic arrivals from Iran and later movements in the Bronze Age from Central Asia that derived ultimately from the Steppe. This study shows how a detailed mtDNA phylogeographic approach, combining both modern and ancient variation, can provide evidence of population movements, even in a scenario of strong male bias such as in the case of the Bronze Age Steppe dispersals., M.S., P.J., S.R., G.O.-G., K.D., G.F., A.F., B.Y., M.P., and M.B.R. received support from the Leverhulme Trust Doctoral Scholarship programme. This work was partially supported by the Portuguese Foundation for Science and Technology (FCT), through the project PTDC/EPH-ARQ/4164/2014 partially funded by European Regional Development Fund (FEDER) (COMPETE 2020 project 016899). P.S. was supported by FCT, ESF and POPH through the FCT Investigator Programme (IF/01641/2013) and acknowledges FCT IP and ERDF (COMPETE2020 -POCI) for the CBMA strategic programme UID/BIA/04050/2013 (POCI-01-0145-FEDER-007569). T.R. is supported by an FCT grant (SFRH/BPD/108126/2015) and acknowledges the project [NORTE-01-0145-FEDER-000013], supported by NORTE 2020-Portugal 2020, through FEDER.

Introduction Prior studies suggest overuse of nonrecommended lung cancer screening tests in U.S. community practice and underuse of recommended tests. Methods Data from the 2010 and 2015 National Health Interview Surveys was analyzed from 2016 to 2018. Prevalence, populations, and number of chest computed tomography (CT) and chest x-ray tests were estimated for people who did and did not meet U.S. Preventive Services Task Force (USPSTF) criteria for lung cancer screening, among people aged ≥40 years without lung cancer. Results In 2015, among those who met USPSTF criteria, 4.4% (95% CI=3.0%, 6.6%), or 360,000 (95% CI=240,000, 535,000) people reported lung cancer screening with a chest CT; and 8.5% (95% CI=6.5%, 11.1%), or 689,000 (95% CI=526,000, 898,000) people reported a chest x ray. Among those who did not meet USPSTF criteria, 2.3% (95% CI=2.0%, 2.6%), or 3,259,000 (95% CI=2,850,000, 3,724,000) people reported a chest x ray; and 1.3% (95% CI=1.1%, 1.5%), or 1,806,000 (95% CI=1,495,000, 2,173,000) people reported a chest CT. The estimated population meeting USPSTF criteria for lung cancer screening in 2015 was 8,098,000 (95% CI=7,533,000, 8,702,000), which was smaller than the 9,620,000 people (95% CI=8,960,000, 10,325,000) in 2010. Conclusions The number of adults inappropriately screened for lung cancer greatly exceeds the number screened according to USPSTF recommendations, the prevalence of appropriate lung cancer screening is low, and the population meeting USPSTF criteria is shrinking. To realize the potential benefits of screening, better processes to appropriately triage eligible individuals to screening, plus screening with a USPSTF-recommended test, would be beneficial.

BACKGROUND: Longer intervals between prostate-specific antigen (PSA) tests for routine prostate cancer screening can reduce the harms while maintaining the benefits of screening. Limited information has been published on PSA screening frequency. The purpose of this report is to describe the number of PSA tests in the last 5 years reported by men in the United States. METHODS: Using data from National Health Interview Survey Cancer Control Supplements in 2010, 2015, and 2018, the number of PSA tests in the last 5 years reported by men ≥40 years was categorized as 4 to 5 PSA tests, 1 to 3 PSA tests, and no PSA tests. Logistic regression was used to calculate model-adjusted prevalence risk ratios (aPRs) for the number of PSA tests in the last 5 years, adjusting for age, racial-ethnic group, education, marital status, and health insurance. RESULTS: The proportion of men aged ≥70 years who reported 4 to 5 PSA tests in the last 5 years decreased from 37.2% in 2010 to 31.1% in 2018, while the proportion reporting 1 to 3 PSA tests increased from 25.5% to 31.9%. In 2018, aPRs for 4 to 5 PSA tests vs. 1 to 3 PSA tests in the last 5 years were significantly higher among men aged 70 to 79 years than among men aged 55 to 69 years. CONCLUSIONS: Men aged ≥70 years reported a small shift to less intense PSA testing between 2010 and 2018, but PSA testing intensity remained higher in men aged ≥70 years than in men aged 55 to 69 years. Published by Elsevier Inc.

The COVID-19 pandemic forced school closures, resulting in home schooling, more time spent at home and fewer opportunities for physical activity (PA). This study explored factors influencing PA and sedentary behaviours (SB) within the home environment during the first lockdown, starting in March 2020. Twenty semi-structured interviews (20 parents and 23 children, 12 years ± 1.25) were conducted. Data were coded using thematic analysis on NVivo© and concepts from McLeroy’s socioecological model for health promotion were used to analyse the data. Findings indicate that children’s PA and SB at home were influenced by: (i) individual-level factors (e.g., gender, competence, attitudes and motivation); (ii) interpersonal-level factors (e.g., siblings, parents, pets, friends and coaches); (iii) organisation-level factors (e.g., school, clubs and societies), (iv) community-level factors (e.g., home and local environment, access to facilities, social norms, time constraints and home equipment), and (v) policy-level factors (e.g., lockdown restrictions). Stay-at-home mandates resulted in perceived reductions in PA and increases in SB within the home; however, this provided alternative positive opportunities for families, including more time to spend together and exploring green and blue spaces in the local area.