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Many interventional in-patient COVID-19 trials assess primary outcomes through day 28 post-randomization. Since a proportion of patients experience protracted disease or relapse, such follow-up period may not fully capture the course of the disease, even when randomization occurs a few days after hospitalization.Among adults hospitalized with COVID-19 in Eastern Denmark from March 18, 2020 - January 12, 2021 we assessed: all-cause mortality, recovery and sustained recovery 90 days after admission, and readmission and all-cause mortality 90 days after discharge. Recovery was defined as hospital discharge and sustained recovery as recovery and alive without readmissions for 14 consecutive days.Among 3,386 patients included in the study 2,796 (82.6%) reached recovery and 2,600 (77.0%) achieved sustained recovery. Of those discharged from hospital, 556 (19.9%) were readmitted, and 289 (10.3%) died. Overall, the median time to recovery was 6 days (Interquartile range (IQR), 3-10), and 19 days (IQR, 11-33) among patients in intensive care in the first two days of admission.Post-discharge readmission and mortality rates were substantial. Therefore, sustained recovery should be favored to recovery outcomes in clinical COVID-19 trials. A 28-day follow-up period may be too short the critically ill.

11 pags., 8 figs., Wave functions, phase shifts, and corresponding elastic cross sections are investigated for two short-range interacting particles in a deformed external oscillator field. For this we use the equivalent d method employing a noninteger dimension d. Using a square-well potential, we derive analytic expressions for scattering lengths and phase shifts. In particular, we consider the dimension, dE, for infinite scattering length, where the Efimov effect occurs by addition of a third particle. We give explicitly the equivalent continuum wave functions in d and ordinary three-dimensional space, and show that the phase shifts are the same in both methods. Consequently the d method can be used to obtain low-energy two-body elastic cross sections in an external field., This work has been partially supported by the Ministerio de Ciencia e Innovación MCI/AEI/FEDER,UE (Spain) under Contract No. PGC2018-093636-B-I00.

This article reconsiders traditional topics in nonlinear elastic waves and nonlinear ultrasonics. Herein, higher-order coupling between finite initial deformation and finite amplitude waves are considered. To allow for coupling, a large-on-large deformation model is developed and used to generate the equations of motion relative to the deformed and undeformed material configurations. Thus, the equations of motion provide a single setting to describe topics in nonlinear elastic waves such as acoustoelasticity, second harmonic generation, and coupling relations between these topics. The model is evaluated to recover the traditional linearized acoustoelastic relations and predicted second harmonic amplitudes. Then, the so-called large acoustoelasticity theory is developed for anisotropic materials with specific results given for isotropic materials. Last, the stress influence on second harmonic generation is presented.

Large placebo responses often negatively affect randomized controlled trials within the pain area. Understanding different possible factors that influence the placebo response is therefore important. In this retrospective analysis, we hypothesized that a large variability in baseline pain score would predict a greater placebo response and analyzed the impact of the coefficient of variation, SD, and difference between the highest and lowest numeric rating scale (NRS) score at baseline on the placebo response. A total of 160 observations on placebo response from 3 controlled clinical trials with a crossover design were included in this study. In general, the placebo response was low with a mean reduction in pain intensity of 0.5 points (range -5 to 7) measured on a 0 to 10 point NRS, and only 15% were placebo responders as defined by more than 30% reduction in NRS pain score from baseline to the end of the placebo treatment period. We found no significant impact of baseline pain coefficient of variation, SD, or the difference between lowest and highest baseline pain score on the placebo response. Placebo response in one trial did not predict placebo response in another trial. A large placebo response was not associated with a large treatment response. In conclusion, in this retrospective data analysis, there was no impact of baseline pain variability on the placebo response in controlled clinical trials with a crossover design in patients with peripheral neuropathic pain.

Metabolic caging is an important tool for quantitative urine and feces collection in rodents, although significant limitations and problems accompany its use. Despite strong opinions among investigators regarding the effects of metabolic caging on energy and fluid homeostasis, careful quantitative analysis of the impact of this caging type—particularly when used for mice—is lacking. The current study assessed the effects of metabolic caging, with or without modifications such as plastic platform inserts, on ingestive behaviors, energy expenditure, accuracy of urine and fecal collection, and ambulatory activities in male C57BL/6J mice. Housing mice in metabolic cages, regardless of platform inclusion, increased energy expenditure without modifying food intake, presumably due to the inability of mice to perform normal thermoregulatory behaviors (burrowing and huddling). Surprisingly, mice in metabolic cages actively avoided platforms, and the inclusion of platforms modified the behavior of the mice and had position-dependent effects that reduced the accuracy of urine collection. Moving mice from cohousing to individual housing in home cages also increased ingestive behaviors and energy expenditure. We conclude that single housing of male C57BL/6J mice increases energy expenditure, that this increase is potentiated in metabolic caging conditions, and that platforms in metabolic cages alter mouse behavior and urine collection. Additional future work is needed to determine the potential benefits of using higher ambient temperature for studies of mice in metabolic caging and whether the above effects occur in females and other strains of mice and other rodent species.

Objective Motor Unit Number Estimation (MUNE) methods may be valuable in tracking motor unit loss in diabetic polyneuropathy (DPN). Muscle Velocity Recovery Cycles (MVRCs) provide information about muscle membrane properties. This study aimed to examine the utility of the MScanFit MUNE in detecting motor unit loss and to test whether the MVRCs could improve understanding of DPN pathophysiology. Methods Seventy-nine type-2 diabetic patients were compared to 32 control subjects. All participants were examined with MScanFit MUNE and MVRCs in anterior tibial muscle. Lower limb nerve conduction studies (NCS) in peroneal, tibial and sural nerves were applied to diagnose large fiber neuropathy. Results NCS confirmed DPN for 47 patients (DPN + ), with 32 not showing DPN (DPN−). MScanFit showed significantly decreased MUNE values and increased motor unit sizes, when comparing DPN + patients with controls (MUNE = 71.3 ± 4.7 vs 122.7 ± 3.8), and also when comparing DPN− patients (MUNE = 103.2 ± 5.1) with controls. MVRCs did not differ between groups. Conclusions MScanFit is more sensitive in showing motor unit loss than NCS in type-2 diabetic patients, whereas MVRCs do not provide additional information. Significance The MScanFit results suggest that motor changes are seen as early as sensory, and the role of axonal membrane properties in DPN pathophysiology should be revisited.

We describe the heretofore unreported case of an HPV-related carcinoma of the palatine tonsil with distinct areas of squamous cell- and adenoid cystic carcinoma-like differentiation in a 54-year old patient. The morphological, immunophenotypic and molecular findings of the tumor are illustrated. We discuss the parallels between the tumor and HPV-related multiphenotypic sinonasal carcinoma (HMSC) which is well-known to exhibit adenoid cystic carcinoma-like features. A review of the literature of high-risk HPV-associated non-squamous carcinomas of the oropharynx is presented.

The aim of this study was to evaluate the presence and characterization of chemotherapy‐induced neuropathy (CIPN) and neuropathic pain 5 years after adjuvant chemotherapy with docetaxel or oxaliplatin. Patients from an ongoing prospective study, who had received adjuvant chemotherapy with docetaxel or oxaliplatin in 2011 to 2012 were invited to participate. The patients underwent a thorough examination with interview, neurological examination, questionnaires, assessment tools, nerve conduction studies (NCS), quantitative sensory testing, MScan motor unit number estimation (MUNE), and corneal confocal microscopy (CCM). Patients were divided into no, possible, probable, and confirmed CIPN. Out of the 132 eligible patients, 63 agreed to participate: 28 had received docetaxel and 35 had received oxaliplatin. Forty‐one percent had confirmed CIPN, 34% possible or probable CIPN, and 22% did not have CIPN. The CIPN was characterized mainly by sensory nerve fiber loss, with a more pronounced large fiber than small fiber loss but also some motor fiber loss identified on NCS and MUNE. In general, patients had mild neuropathy with relatively low scores on assessment tools and no association with mood and quality of life. CCM was not useful as a diagnostic tool. Of the patients with probable or confirmed CIPN, 30% experienced pain, which was most often mild, but still interfered moderately with daily life in 20% to 25% and was associated with lower quality of life. In conclusion CIPN was confirmed in 41% 5 years after chemotherapy. The neuropathy was generally mild, but in patients with neuropathic pain it was associated with lower quality of life.

Hard carbons, due to their relatively low cost and good electrochemical performance, are considered the most promising anode materials for Na-ion batteries. Despite the many reported structures of ...

Changing climate and land‐use practices have the potential to bring previously isolated populations of pest insects into new sympatry. This heightens the need to better understand how differing patterns of host–plant association, and unique endosymbionts, serve to promote genetic isolation or integration. We addressed these factors in populations of potato psyllid, Bactericera cockerelli (Šulc), a generalist herbivore that vectors a bacterial pathogen (Candidatus Liberibacter solanacearum, causal pathogen of zebra chip disease) of potato (Solanum tuberosum L.). Genome‐wide SNP data revealed two major genetic clusters—psyllids collected from potato crops were genetically similar to psyllids found on a common weed, Lycium spp., but dissimilar from those found on another common non‐crop host, Solanum dulcamara L. Most psyllids found on Lycium spp. and potato represented a single mitochondrial cytochrome oxidase I (COI) haplotype that has been suggested to not be native to the region, and whose arrival may have been concurrent with zebra chip disease first emerging. The putatively introduced COI haplotype usually co‐occurred with endosymbiotic Wolbachia, while the putatively resident COI haplotype generally did not. Genetic intermediates between the two genetic populations of insects were rare, consistent with recent sympatry or reproductive isolation, although admixture patterns of apparent hybrids were consistent with introgression of genes from introduced into resident populations. Our results suggest that both host–plant associations and endosymbionts are shaping the population genetic structure of sympatric psyllid populations associated with different non‐crop hosts. It is of future interest to explicitly examine vectorial capacity of the two populations and their potential hybrids, as population structure and hybridization might alter regional vector capacity and disease outbreaks.

Governance today often requires concerted action by multiple organizations operating within and across sectors. Although scholars fruitfully have assayed many factors that facilitate or constrain interorganizational collaboration, the extant literature largely ignores the ways in which historical patterns of policy and organizational development may figure in present-day obstacles to collaboration. This is unfortunate, for such obstacles may result from path dependence and, thus, be particularly ingrained and resistant to change. In this article, we detail recent advances in path dependency theory, then illustrate our argument with a case study of path-dependent barriers to collaboration between two public programs pressed to work together after decades of deliberately separate operation. The case confirms the utility of new theoretical developments, yet also suggests necessary clarifications and refinements. Though aspects of path dependence theory should be reexamined, we argue that it is ripe for use by scholars of public management concerned with barriers to collaboration and other contemporary governance challenges.

Diabetic polyneuropathy (DPN) is a common complication of diabetes and is often associated with neuropathic pain. The mechanisms underlying development and maintenance of painful DPN are largely unknown, and quantification of intraepidermal nerve fiber density from skin biopsy, one of the neuropathological gold standard when diagnosing DPN, does not differentiate between patients with and without pain. Identification of possible pain pathophysiological biomarkers in patients with painful DPN may increase our knowledge of mechanisms behind neuropathic pain. Animal models of painful DPN have been shown to have an increased density of peptidergic nerve fibers (substance P and calcitonin gene-related peptide). In this study, we performed a detailed skin biopsy analysis in a well-characterized group of DPN patients with primarily small fiber involvement, with and without pain, and in healthy controls and test for correlation between skin biopsy findings and pain intensity and quantitative sensory testing. We found that although there was no difference in intraepidermal nerve fiber density using protein gene product 9.5 between patients with and without pain, patients with pain had increased density of dermal peptidergic fibers containing substance P and calcitonin gene-related peptide compared with patients with painless DPN and healthy controls. Peptidergic nerve fiber density correlated with pain ratings in patients with pain (R = 0.33; P = 0.019), but not with quantitative sensory testing results. In this article, we show, for the first time in humans, an increased density of dermal peptidergic fibers in painful DPN. These findings provide new insight in the pathophysiological mechanisms of pain in diabetes and open the research towards new therapeutic targets.

OBJECTIVE: To estimate long-term stimulant treatment associations on standardized height, weight and BMI trajectories from childhood to adulthood in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder (MTA). METHOD: Of 579 children with DSM-IV ADHD-Combined Type at baseline (ages 7.0–9.9 years) and 289 classmates (local normative comparison group, LNCG), 568 and 258 respectively, were assessed 8 times over 16 years (final mean age = 24.7). Parent interview data established subgroups with self-selected Consistent (N=53, 9%), Inconsistent (N=374, 66%), and Negligible (N=141, 25%) stimulant medication use, as well as cases starting stimulants prior to MTA entry (N=211, 39%). Height and weight growth trajectories were calculated for each subgroup. RESULTS: Height z-scores trajectories differed among subgroups (F=2.22, P

The serotonin 2A receptor (5‐HT2AR) is implicated in the pathophysiology and treatment of various psychiatric disorders. [18F]altanserin and [11C]Cimbi‐36 positron emission tomography (PET) allow for high‐resolution imaging of 5‐HT2AR in the living human brain. Cerebral 5‐HT2AR binding is strongly genetically determined, though the impact of specific variants is poorly understood. Candidate gene studies suggest that HTR2A single nucleotide polymorphisms including rs6311/rs6313, rs6314, and rs7997012 may influence risk for psychiatric disorders and mediate treatment response. Although known to impact in vitro expression of 5‐HT2AR or other serotonin (5‐HT) proteins, their effect on human in vivo brain 5‐HT2AR binding has as of yet been insufficiently studied. We thus assessed the extent to which these variants and the commonly studied 5‐HTTLPR predict neocortex in vivo 5‐HT2AR binding in healthy adult humans. We used linear regression analyses and likelihood ratio tests in 197 subjects scanned with [18F]altanserin or [11C]Cimbi‐36 PET. Although we observed genotype group differences in 5‐HT2AR binding of up to ~10%, no genetic variants were statistically significantly predictive of 5‐HT2AR binding in what is the largest human in vivo 5‐HT2AR imaging genetics study to date. Thus, in vitro and post mortem results suggesting effects on 5‐HT2AR expression did not carry over to the in vivo setting. To any extent these variants might affect clinical risk, our findings do not support that 5‐HT2AR binding mediates such effects. Our observations indicate that these individual variants do not significantly contribute to genetic load on human in vivo 5‐HT2AR binding., We evaluated whether common HTR2A single nucleotide polymorphisms rs6313, rs6314, rs7997012, and the 5‐HTTLPR predict 5‐HT2AR binding, assessed with [18F]altanserin and [11C]Cimbi‐36 positron emission tomography in healthy individuals. This is the largest study to date evaluating genetic predictors of a human in vivo serotonin protein (n = 197). Although relative differences of up to 10% were detected, no statistically significant effect was observed. Our results do not support a significant contribution of these individual variants to genetic load on 5‐HT2AR binding.

Study design Cohort study Objectives The purpose of this study was to evaluate the performance of a re-engineered device (Ferticare 2.0), which is replacing the previous standard (Ferticare 1.0) for penile vibratory stimulation in men with spinal cord injury. Most men with spinal cord injury are anejaculatory, requiring medical assistance to obtain their semen. Penile vibratory stimulation is generally recognized as the standard of care for semen retrieval in these anejaculatory men. Setting Major Research University in Miami, Florida, USA. Methods The Ferticare 2.0 device was applied to 15 men with spinal cord injury in a three-step protocol simulating normal use. Step 1: one device (2.5 mm amplitude, 100 Hz) was applied to the glans penis for 2 min. Step 2: If no ejaculation occurred, the amplitude was increased to 4.0 mm (100 Hz) and the device similarly applied. Step 3: If no ejaculation occurred, two devices, each 2.5 mm and 100 Hz were applied to the dorsum and frenulum of the glans penis. Participants at risk for autonomic dysreflexia were pretreated with sublingual nifedipine (20 mg), 15 min prior to stimulation. Blood pressure and other symptoms of autonomic dysreflexia were monitored. Participants answered a questionnaire about their experience with the device. Results Thirteen of 15 participants ejaculated with the device. No adverse events occurred. All participants commented they would recommend the device to other men with spinal cord injury. Conclusions A re-engineered device, the Ferticare 2.0, is safe and effective for inducing ejaculation in men with spinal cord injury.

On 11 March 2020, the World Health Organization declared SARS-CoV-2 and its associated disease, COVID-19, a global pandemic. Across the world, governments took action to slow the spread and hospitals rushed to accommodate an influx of patients with this highly infectious and lethal disease. The urology departments in Ann Arbor, Michigan, USA, and Herlev and Gentofte, Copenhagen, Denmark — which are linked by the pre-existing CopMich Collaborative — had to respond with massive changes to the organization, staffing and workload of their teams. In this Viewpoint, authors from different urological subspecialties and at different career stages reflect on their experiences during the pandemic. Although their countries’ responses to the COVID-19 pandemic differed radically, the similarities between the responses in Copenhagen and Michigan demonstrate the universal characteristics of medicine and the value of teamwork, flexibility and collaboration., The contributors Juan J. Andino is a third-year urology resident at the University of Michigan. He completed his undergraduate and medical degrees, and an MBA at the University of Michigan. Dr Andino is interested in telehealth and health policy and hopes to work at the intersection of these fields to optimize the delivery of urological care. James M. Dupree is an Associate Professor of Urology at the University of Michigan. He completed his residency at Northwestern University and his fellowship in Male Reproductive Medicine and Surgery at Baylor College of Medicine. He also completed a Health Policy Fellowship with the American College of Surgeons. Dr Dupree specializes in the advanced treatment of male infertility, and his research focuses on male infertility and reproductive health policy. Dr Dupree is also the Ambulatory Care Clinical Chief for Urology at the University of Michigan. Christian Fuglesang S. Jensen received his medical degree from the University of Copenhagen in 2015 and is currently enrolled as a PhD trainee working with male infertility at the Department of Urology, Herlev and Gentofte Hospital. Dr Jensen has previously worked at the Department of Urology, University of Michigan, performing research into andrology and male infertility. Dr Jensen serves as chair on the ESSM Scientific Sub-Committee for new technologies and sexual function and is a co-founder and member of the Core Unit of the CopMich Collaborative. Ganesh S. Palapattu is the George F. and Sandy G. Valassis Professor and Chair of the Department of Urology at the University of Michigan. He attended the University of Texas at Austin where he earned a Bachelor of Arts degree in Humanities and then Baylor College of Medicine in Houston, Texas, where he earned his medical degree. Subsequently, Dr Palapattu completed his surgical internship, urology training and chief residency in urology at the David Geffen School of Medicine at UCLA followed by a laboratory research fellowship in Urologic Oncology at the Johns Hopkins Hospital Brady Urological Institute. His clinical interest is in the evaluation and management of men with prostate and kidney cancer. Jens Sønksen received his medical degree from the University of Copenhagen in 1988 and earned his PhD and Doctor of Medical Science in 1995 and 2003, respectively. He is currently Professor of Urology at the University of Copenhagen and Head of the Urological Research Center and Section of Andrology, Herlev and Gentofte Hospital, Denmark. Dr Sønksen is currently serving as Adjunct Secretary General of the European Association of Urology and is a co-founder and member of the Core Unit of the CopMich Collaborative. Daniela Wittmann received her BA Hons at Keele University, Keele, UK, her Master’s in Social Work at Simmons College School of Social Work, Boston, MA and her PhD at Michigan State University. She is an Associate Professor in the Department of Urology and Adjunct Associate Professor at the School of Social Work at the University of Michigan. Dr Wittmann is a leading member of the Brandon Prostate Cancer Survivorship Program at the University of Michigan and serves as the Chair of the Mental Health Committee of the Sexual Medicine Society of North America. She is also a member of the Prostate Health Committee of the Urology Care Foundation.

Torsion of the spermatic cord is a urological emergency that must be treated with acute surgery. Possible long-term effects of torsion on testicular function are controversial. This review aims to address the impact of testicular torsion (TT) on the endocrine- and exocrine-function of the testis, including possible negative effects of torsion on the function of the contralateral testis. Testis tissue survival after TT is dependent on the degree and duration of TT. TT has been demonstrated to cause long-term decrease in sperm motility and reduce overall sperm counts. Reduced semen quality might be caused by ischemic damage and reperfusion injury. In contrast, most studies find endocrine parameters to be unaffected after torsion, although few report minor alterations in levels of gonadotropins and testosterone. Contralateral damage after unilateral TT has been suggested by histological abnormalities in the contralateral testis after orchiectomy of the torsed testis. The evidence is, however, limited as most human studies are small case-series. Theories as to what causes contralateral damage mainly derive from animal studies making it difficult to interpret the results in a human context. Large long-term follow-up studies are needed to clearly uncover changes in testicular function after TT and to determine the clinical impact of such changes.

Computing path queries such as the shortest path in public transport networks is challenging because the path costs between nodes change over time. A reachability query from a node at a given start time on such a network retrieves all points of interest (POIs) that are reachable within a given cost budget. Reachability queries are essential building blocks in many applications, for example, group recommendations, ranking spatial queries, or geomarketing. We propose an efficient solution for reachability queries in public transport networks. Currently, there are two options to solve reachability queries. (1) Execute a modified version of Dijkstra’s algorithm that supports time-dependent edge traversal costs; this solution is slow since it must expand edge by edge and does not use an index. (2) Issue a separate path query for each single POI, i.e., a single reachability query requires answering many path queries. None of these solutions scales to large networks with many POIs. We propose a novel and lightweight reachability index. The key idea is to partition the network into cells. Then, in contrast to other approaches, we expand the network cell by cell. Empirical evaluations on synthetic and real-world networks confirm the efficiency and the effectiveness of our index-based reachability query solution.

Background/Aims Endoscopic ultrasound (EUS)-guided fine-needle aspiration is very effective for providing specimens for cytological evaluation. However, the ability to provide sufficient tissue for histological evaluation has been challenging due to the technical limitations of dedicated core biopsy needles. Recently, a modified EUS needle has been introduced to obtain tissue core samples for histological analysis. We aimed to determine (1) its ability to obtain specimens for histological assessment and (2) the diagnostic accuracy of EUS-guided fine-needle biopsy (EUS-FNB) using this needle. Methods We retrospectively analyzed consecutive cases of FNB using modified EUS needles for 342 lesions in 303 patients. The cytology and histological specimens were analyzed. Diagnostic accuracy was calculated. Results Adequate cytological and histological assessment was possible in 293/342 (86%) and 264/342 (77%) lesions, respectively. Diagnostic accuracy of the cytological specimen was 294/342 (86%) versus 254/342 (74%) for the histological specimen (p

Objective: Sex steroid hormones potently shape brain functions, including those critical to maintain mental health such as serotonin signaling. Use of oral contraceptives (OCs) profoundly changes endogenous sex steroid hormone levels and dynamics. Recent register-based studies show that starting an OC is associated with increased risk of developing depression. Here, we investigate whether use of OCs in healthy women is associated with a marker of the serotonin system in terms of serotonin 4 receptor (5-HT4R) brain imaging. Methods: [11C]SB207145-PET imaging data on 53 healthy women, of whom 16 used OCs, were available from the Cimbi database. We evaluated global effects of OC use on 5-HT4R binding in a latent variable model based on 5-HT4R binding across cortical and subcortical regions. Results: We demonstrate that OC users have 9–12% lower global brain 5-HT4R binding potential compared to non-users. Univariate region-based analyses (pallidostriatum, caudate, hippocampus, amygdala, anterior cingulate cortex, and neocortex) supported the global effect of OC use with the largest difference present in the hippocampus (−12.8% (95% CI [−21.0; −3.9], Pcorrected = 0.03). Conclusion: We show that women who use OCs have markedly lower brain 5-HT4R binding relative to non-users, which constitutes a plausible molecular link between OC use and increased risk of depressive episodes. We propose that this reflects a reduced 5-HT4R gene expression, possibly related to a blunted ovarian hormone state among OC users.

Introduction Many patients seek information online including on social media. Aim To assess the quality of information regarding erectile dysfunction (ED) in YouTube videos. Methods We searched “erectile dysfunction” on YouTube in October 2019 and evaluated the first 100 videos in English sorted by relevance. Main Outcome Measure We recorded the user engagement, video producer, intended audience, and content. Videos containing medical information were evaluated using the Patient Education Materials Assessment Tool (PEMAT) and the DISCERN quality criteria for consumer health information. The PEMAT evaluates the understandability and actionability of materials as a percentage. The DISCERN assesses the quality of information by a scale from 1 (serious or extensive shortcomings) to 5 (minimal shortcomings). Results The median number of total views was 22,450 (range 591–20,255,133) and the median number of views/month was 654 (range 9–723,398). 42 percent of the videos were posted by professional medical institutions, and 21% were posted by individual medical professionals. Most videos were aimed at the general public or patients suffering from ED. The median PEMAT understandability and actionability scores were both 100% (range 50–100% and 33–100%, respectively). The median DISCERN score was 2 (range 1-5) with 80.4% receiving a score of ≤3. Overall, 28% of the videos contained direct misinformation. DISCERN scores were higher in videos produced by medical institutions (P = .0104), not selling specific products (P = .007) and not promoting alternative medicine (P = .0002). The number of subscribers was an independent predictor of views/month (P < .0001). Conclusion Patients may be exposed to videos of poor quality when searching for information about ED on YouTube. The medical community needs to adapt a strategy to improve the quality of online medical information.

Increasingly massive volumes of vehicle trajectory data hold the potential to enable higher-resolution traffic services than hitherto possible. We use trajectory data to create a high-resolution, uncertain road-network graph, where edges are associated with travel-time distributions. In this setting, we study probabilistic budget routing that aims to find the path with the highest probability of arriving at a destination within a given time budget. A key challenge is to compute accurately and efficiently the travel-time distribution of a path from the travel-time distributions of the edges in the path. Existing solutions that rely on convolution assume independence among the distributions to be convolved, but as distributions are often dependent, the result distributions exhibit poor accuracy. We propose a hybrid approach that combines convolution with estimation based on machine learning to account for dependencies among distributions in order to improve accuracy. Since the hybrid approach cannot rely on the independence assumption that enables effective pruning during routing, naive use of the hybrid approach is costly. To address the resulting efficiency challenge, we propose an anytime routing algorithm that is able to return a "good enough" path at any time and that eventually computes a high-quality path. Empirical studies involving a substantial real-world trajectory set offer insight into the design properties of the proposed solution, indicating that it is practical in real-world settings.

OBJECTIVE To investigate the association of metabolic and lifestyle factors with possible diabetic polyneuropathy (DPN) and neuropathic pain in patients with early type 2 diabetes. RESEARCH DESIGN AND METHODS We thoroughly characterized 6,726 patients with recently diagnosed diabetes. After a median of 2.8 years, we sent a detailed questionnaire on neuropathy, including the Michigan Neuropathy Screening Instrument questionnaire (MNSIq), to identify possible DPN (score ≥4) and the Douleur Neuropathique en 4 Questions (DN4) questionnaire for possible associated neuropathic pain (MNSIq ≥4 + pain in both feet + DN4 score ≥3). RESULTS Among 5,249 patients with data on both DPN and pain, 17.9% (n = 938) had possible DPN, including 7.4% (n = 386) with possible neuropathic pain. In regression analyses, central obesity (waist circumference, waist-to-hip ratio, and waist-to-height ratio) was markedly associated with DPN. Other important metabolic factors associated with DPN included hypertriglyceridemia ≥1.7 mmol/L, adjusted prevalence ratio (aPR) 1.36 (95% CI 1.17; 1.59); decreased HDL cholesterol CONCLUSIONS Possible DPN was associated with metabolic syndrome factors, insulin resistance, inflammation, and modifiable lifestyle habits in early type 2 diabetes.