Fully-automated deep learning-based flow quantification of 2D CINE phase contrast MRI.

OBJECTIVES: Time-resolved, 2D-phase-contrast MRI (2D-CINE-PC-MRI) enables in vivo blood flow analysis. However, accurate vessel contour delineation (VCD) is required to achieve reliable results. We sought to evaluate manual analysis (MA) compared to the performance of a deep learning (DL) application for fully-automated VCD and flow quantification and corrected semi-automated analysis (corSAA). METHODS: We included 97 consecutive patients (age = 52.9 ± 16 years, 41 female) with 2D-CINE-PC-MRI imaging on 1.5T MRI systems at sinotubular junction (STJ), and 28/97 also received 2D-CINE-PC at main pulmonary artery (PA). A cardiovascular radiologist performed MA (reference) and corSAA (built-in tool) in commercial software for all cardiac time frames (median: 20, total contours per analysis: 2358 STJ, 680 PA). DL-analysis automatically performed VCD, followed by net flow (NF) and peak velocity (PV) quantification. Contours were compared using Dice similarity coefficients (DSC). Discrepant cases (> ± 10 mL or > ± 10 cm/s) were reviewed in detail. RESULTS: DL was successfully applied to 97% (121/125) of the 2D-CINE-PC-MRI series (STJ: 95/97, 98%, PA: 26/28, 93%). Compared to MA, mean DSC were 0.91 ± 0.02 (DL), 0.94 ± 0.02 (corSAA) at STJ, and 0.85 ± 0.08 (DL), 0.93 ± 0.02 (corSAA) at PA; this indicated good to excellent DL-performance. Flow quantification revealed similar NF at STJ (p = 0.48) and PA (p > 0.05) between methods while PV assessment was significantly different (STJ: p < 0.001, PA: p = 0.04). A detailed review showed noisy voxels in MA and corSAA impacted PV results. Overall, DL analysis compared to human assessments was accurate in 113/121 (93.4%) cases. CONCLUSIONS: Fully-automated DL-analysis of 2D-CINE-PC-MRI provided flow quantification at STJ and PA at expert level in > 93% of cases with results being available instantaneously. KEY POINTS: • Deep learning performed flow quantification on clinical 2D-CINE-PC series at the sinotubular junction and pulmonary artery at the expert level in > 93% of cases. • Location detection and contouring of the vessel boundaries were performed fully-automatic with results being available instantaneously compared to human assessments which approximately takes three minutes per location. • The evaluated tool indicates usability in daily practice.

Emotional Reactions to COVID-19 Projections and Consequences for Protective Policies and Personal Behavior.

How does the public react to information about the likely progression of COVID-19 cases in the United States? How do these reactions vary over the course of the pandemic and by partisanship, and with what consequences for policy attitudes and personal behavior? We argue that reading projections about the peak of COVID-19 cases in the United States is likely to lead to increased levels of anxiety and sadness. We expect that these effects will be more pronounced and less polarized along partisan lines earlier in the pandemic. Finally, we expect that elevated anxiety and sadness should in turn lead to greater support for protective policies to combat the pandemic and a greater inclination to engage in protective behaviors. To test these arguments, we fielded online survey experiments at three points in time (April, June, and August 2020), in which respondents were randomly assigned to a control group or one of two projections about the likely progression of COVID-19 cases in the United States. Across all three waves, we find that exposure to information about case peaks increases anxiety and sadness, though the effects get weaker over time, particularly among Republicans. We also find evidence that these elevated emotional responses increase support for protective policies and behavior.

Stay-at-home orders associate with subsequent decreases in COVID-19 cases and fatalities in the United States.

Governments issue "stay-at-home" orders to reduce the spread of contagious diseases, but the magnitude of such orders' effectiveness remains uncertain. In the United States these orders were not coordinated at the national level during the coronavirus disease 2019 (COVID-19) pandemic, which creates an opportunity to use spatial and temporal variation to measure the policies' effect. Here, we combine data on the timing of stay-at-home orders with daily confirmed COVID-19 cases and fatalities at the county level during the first seven weeks of the outbreak in the United States. We estimate the association between stay-at-home orders and alterations in COVID-19 cases and fatalities using a difference-in-differences design that accounts for unmeasured local variation in factors like health systems and demographics and for unmeasured temporal variation in factors like national mitigation actions and access to tests. Compared to counties that did not implement stay-at-home orders, the results show that the orders are associated with a 30.2 percent (11.0 to 45.2) average reduction in weekly incident cases after one week, a 40.0 percent (23.4 to 53.0) reduction after two weeks, and a 48.6 percent (31.1 to 61.7) reduction after three weeks. Stay-at-home orders are also associated with a 59.8 percent (18.3 to 80.2) average reduction in weekly fatalities after three weeks. These results suggest that stay-at-home orders might have reduced confirmed cases by 390,000 (170,000 to 680,000) and fatalities by 41,000 (27,000 to 59,000) within the first three weeks in localities that implemented stay-at-home orders.

Not by turnout alone: Measuring the sources of electoral change, 2012 to 2016.

Changes in partisan outcomes between consecutive elections must come from changes in the composition of the electorate or changes in the vote choices of consistent voters. How much composition versus conversion drives electoral change has critical implications for the policy mandates of election victories and campaigning and governing strategies. Here, we analyze electoral change between the 2012 and 2016 U.S. presidential elections using administrative data. We merge precinct-level election returns, the smallest geography at which vote counts are available, with individual-level turnout records from 37 million registered voters in six key states. We find that both factors were substantively meaningful drivers of electoral change, but the balance varied by state. We estimate that pro-Republican Party (GOP) conversion among two-election voters was particularly important in states including Ohio, Michigan, and Pennsylvania where the pro-GOP swings were largest. Our results suggest conversion remains a crucial component of electoral change.

The small effects of political advertising are small regardless of context, message, sender, or receiver: Evidence from 59 real-time randomized experiments.

Evidence across social science indicates that average effects of persuasive messages are small. One commonly offered explanation for these small effects is heterogeneity: Persuasion may only work well in specific circumstances. To evaluate heterogeneity, we repeated an experiment weekly in real time using 2016 U.S. presidential election campaign advertisements. We tested 49 political advertisements in 59 unique experiments on 34,000 people. We investigate heterogeneous effects by sender (candidates or groups), receiver (subject partisanship), content (attack or promotional), and context (battleground versus non-battleground, primary versus general election, and early versus late). We find small average effects on candidate favorability and vote. These small effects, however, do not mask substantial heterogeneity even where theory from political science suggests that we should find it. During the primary and general election, in battleground states, for Democrats, Republicans, and Independents, effects are similarly small. Heterogeneity with large offsetting effects is not the source of small average effects.

America's electorate is increasingly polarized along partisan lines about voting by mail during the COVID-19 crisis.

Are voters as polarized as political leaders when it comes to their preferences about how to cast their ballots in November 2020 and their policy positions on how elections should be run in light of the COVID-19 outbreak? Prior research has shown little party divide on voting by mail, with nearly equal percentages of voters in both parties choosing to vote this way where it is an option. Has a divide opened up this year in how voters aligned with the Democratic and Republican parties prefer to cast a ballot? We address these questions with two nationally diverse, online surveys fielded from April 8 to 10 and June 11 to 13, of 5,612 and 5,818 eligible voters, respectively, with an embedded experiment providing treated respondents with scientific projections about the COVID-19 outbreak. We find a nearly 10 percentage point difference between Democrats and Republicans in their preference for voting by mail in April, which had doubled in size to nearly 20 percentage points in June. This partisan gap is wider still for those exposed to scientific projections about the pandemic. We also find that support for national legislation requiring states to offer no-excuse absentee ballots has emerged as an increasingly polarized issue.

Local demographic changes and US presidential voting, 2012 to 2016.

Immigration and demographic change have become highly salient in American politics, partly because of the 2016 campaign of Donald Trump. Previous research indicates that local influxes of immigrants or unfamiliar ethnic groups can generate threatened responses, but has either focused on nonelectoral outcomes or analyzed elections in large geographic units, such as counties. Here, we examine whether demographic changes at low levels of aggregation were associated with vote shifts toward an anti-immigration presidential candidate between 2012 and 2016. To do so, we compile a precinct-level dataset of election results and demographic measures for almost 32,000 precincts in the states of Florida, Georgia, Michigan, Nevada, Ohio, Pennsylvania, and Washington. We employ regression analyses varying model specifications and measures of demographic change. Our estimates uncover little evidence that influxes of Hispanics or noncitizen immigrants benefited Trump relative to past Republicans, instead consistently showing that such changes were associated with shifts to Trump's opponent.

The voting experience and beliefs about ballot secrecy.

New democracies go to great lengths to implement institutional protections of the electoral process. However, in this paper we present evidence that shows that even in the United States-where the secret ballot has been in place for generations-doubts about the secrecy of the voting process are surprisingly prevalent. Many say that their cast ballot can be matched to their name or that others could observe their vote choices while they were voting. We find that people who have not previously voted are particularly likely to harbor doubts about the secrecy of voters' ballots. Those who vote by mail in the privacy of their own homes also feel that others are able to discover their vote choices. Taken together, these findings suggest an important divergence between public perceptions about and the institutional status of the secret ballot in the United States, a divergence that may affect patterns of voting behavior and political participation.

Patient and Tumor Disparities in Breast Cancer Based on Insurance Status.

This study seeks to determine whether uninsured breast cancer patients are more likely to present with advanced disease relative to insured patients. We retrospectively reviewed newly diagnosed breast cancer patients over a 27-month period. Patients were sorted based on insurance status at diagnosis. Demographic and tumor-specific data were collected and analyzed using nonparametric testing. We identified 276 breast tumors in 260 patients. Out of the 260 patients, 71 patients (27.3%) were uninsured and were more likely to be black (P < 0.05), present with a breast-specific complaint rather than an abnormal mammogram (P < 0.05), and present with more advanced disease (52% stage II or worse vs 26.6% in the insured population; P < 0.01). Percentage of invasive carcinoma and tumor biology were independent of insurance status. Insured patients were more likely to receive surgery as first therapy (76.5 vs 46.0%, P < 0.01), whereas uninsured patients were more likely to receive chemotherapy suggesting multimodality treatment. Uninsured patients had a longer time to therapy initiation (56.0 days vs 44.5 days, P < 0.05). Our study confirms that uninsured patients present with higher stage disease are more likely to have breast-specific complaints and are more likely to require chemotherapy as first-line treatment confirming the under-utility of screening mammography within our uninsured patients.

Effects of pill burden on discontinuation of the initial HAART regimen in minority female patients prescribed 1 pill/day versus any other pill burden.

Highly active antiretroviral therapy (HAART) is a mainstay of treatment for patients with Human Immunodeficiency Virus (HIV). Since second line HAART therapies can be costlier and less effective, it is essential to understand the duration of initial HAART therapies. The overall aim of this study was to estimate the effects of daily pill burden on the time to discontinuation of the initial HAART regimen. Patients were initially identified through the clinic's CAREWARE database. A chart review was conducted for data collection, where only adult, female, HIV-positive patients initiating therapy at the study clinic between 1 January 2001 and 31 December 2011 were included. All study subjects were followed up from the initiation of HAART to treatment discontinuation. A Kaplan-Meier curve was generated to describe time to discontinuation by regimens, and a Cox proportional hazards model was developed to assess the impact of different regimen and patient demographic characteristics on the hazard of discontinuation of the initial regimen. A total of 498 charts were initially reviewed. After assessment of these patients for inclusion criteria, a cohort of 115 adult female patients who initiated HAART at the study clinic was included. Patients treated with 1 pill/day regimen had a significantly longer time to discontinuation than regimens of >1 pills/day (mean duration of initial therapy was 1062.56 days vs. 631.70 days, respectively, p = 0.003). Compared to 1 pill/day regimens, >1 pills/day regimens were associated with a higher hazard of discontinuation (hazard ratio (HR) =3.44 with 95% confidence interval (CI) = 1.25, 9.48). A higher viral load and patients without insurance were also found to be significantly associated with increased hazards of discontinuation. Overall, female HIV patients initiating therapy with the 1 pill/day HAART regimen were less likely to discontinue their treatment compared to patients initiating with >1 pills/day HAART regimen.

How should primary care doctors select which antidepressants to administer?

Clinicians can choose among various second-generation antidepressants for treating depressive disorders, such as major depressive disorder, subsyndromal depression, or dysthymia. Systematic reviews indicate that available drugs differ in frequency of administration, costs, and the risks of some adverse events but have similar efficacy for treating major depressive disorder. Furthermore, evidence does not support the choice of one antidepressant over another based on accompanying symptoms, such anxiety, insomnia, or pain. Available studies provide little guidance for clinicians about the benefits of second-generation antidepressants for treating dysthymia and subsyndromal depression. Evidence is also unclear about the comparative risks of serious adverse events, such as suicidality, seizures, fractures, increased bleeding, or serotonin syndrome. This article summarizes the best available evidence regarding comparative benefits and harms of second-generation antidepressants for treating depressive disorders.

Motivational interviewing as a behavioral intervention to increase HAART adherence in patients who are HIV-positive: a systematic review of the literature.

As HIV infection rates continue to rise, more and more people are faced with a complex, life-altering highly active antiretroviral therapy (HAART) regimen. With some researchers reporting as few as 50-70% of patients achieving adherence in the first six months of a HAART regimen, many behavioral interventions to increase HAART adherence have been examined. One such intervention, motivational interviewing (MI), has shown promise in previous studies and reviews as a possible successful intervention. Researchers conducted a review of the literature to identify studies analyzing the effect of a MI intervention on HAART adherence, with the objectives of examining this relationship and identifying gaps in the literature. To draw definitive conclusions about these questions and to maintain high methodological quality in the search, researchers used the Cochrane method for systematic reviews while conducting this review. Five studies were retained for review from the search and all were RCTs. Sample sizes ranged from 141 to 326 patients. Three of the five studies showed a significant increase in adherence rates, two studies reported a significant decrease in viral load, and one study showed an increase in CD4 cell count as a result of the intervention. A lack of a universally accepted definition of adherence and large gaps in the areas of humanistic and economic outcomes in the literature creates challenges in comparing improvements in HAART adherence across studies. Despite these challenges in comparison, MI appears to be a promising intervention to improve HAART adherence in HIV-positive individuals, but further studies of rigorous methodological quality are needed to fully understand the effect of this intervention.