Treating Erythromelalgia with Interosseous Membrane Stimulation: An Autonomic Basis for the Condition and Its Treatment.

Background: Erythromelalgia, which has primary and secondary presentations, causes heat, pain, and redness in the skin. The condition seems to have an autonomic basis, with vasomotor dysfunction causing dilatation of some blood vessels and constriction of others. No consistently effective treatments have been reported. Anticonvulsant, antidepressant, antihistamine, anti-inflammatory, antihypertensive, analgesic, nutritional, and topical approaches have been tried as were lidocaine infusions, nerve blocks, and thoracic and lumbar sympathectomies. Interosseous membrane stimulation appears to affect the local autonomic milieu in the extremity being treated. This approach was used on a patient with erythromelalgia. Case: A 36-year-old woman with erythromelalgia was treated with interosseous membrane stimulation. Eight treatments were given over a 1-year timeframe at 1-3-month intervals. Results: This patient repeatedly experienced much relief from her burning paresthesias, swelling, diaphoresis, and ruddy discoloration of her extremities for 6-8 hours following each treatment. The intensity of her discomfort subsided gradually over time. Conclusions: Interosseous membrane stimulation is a safe, simple, and effective treatment for erythromelalgia, which is notoriously refractory to treatment. This patient's response to treatment might have been a result of localized derangement of her autonomic nervous system. It is possible that manipulation of the autonomic milieu of an extremity is a significant factor in the mechanism of action of interosseous membrane stimulation.

The acceptance of evolution: A developmental view of Generation X in the United States.

The public acceptance of evolution remains a contentious issue in the United States. Numerous investigations have used national cross-sectional studies to examine the factors associated with the acceptance or rejection of evolution. This analysis uses a 33-year longitudinal study that followed the same 5000 public-school students from grade 7 through midlife (ages 45-48) and is the first to do so in regard to evolution. A set of structural equation models demonstrate the complexity and changing nature of influences over these three decades. Parents and local influences are strong during the high school years. The combination of post-secondary education and occupational and family choices demonstrate that the 15 years after high school are the switchyards of life.

Cancer Mortality Among Solid Organ Transplant Recipients in the United States During 1987-2018.

BACKGROUND: Solid organ transplant recipients (ie, "recipients") have elevated cancer risk and reduced survival after a cancer diagnosis. Evaluation of cancer mortality among recipients can facilitate improved outcomes from cancers arising before and after transplantation. METHODS: We linked the US transplant registry to the National Death Index to ascertain the causes of 126 474 deaths among 671 127 recipients (1987-2018). We used Poisson regression to identify risk factors for cancer mortality and calculated standardized mortality ratios to compare cancer mortality in recipients with that in the general population. Cancer deaths verified with a corresponding cancer diagnosis from a cancer registry were classified as death from pretransplant or posttransplant cancers. RESULTS: Thirteen percent of deaths were caused by cancer. Deaths from lung cancer, liver cancer, and non-Hodgkin lymphoma (NHL) were the most common. Heart and lung recipients had the highest mortality for lung cancer and NHL, whereas liver cancer mortality was highest among liver recipients. Compared with the general population, cancer mortality was elevated overall (standardized mortality ratio 2.33; 95% confidence interval, 2.29-2.37) and for most cancer sites, with large increases from nonmelanoma skin cancer (23.4, 21.5-25.5), NHL (5.17, 4.87-5.50), kidney cancer (3.40, 3.10-3.72), melanoma (3.27, 2.91-3.68), and, among liver recipients, liver cancer (26.0, 25.0-27.1). Most cancer deaths (93.3%) were associated with posttransplant cancer diagnoses, excluding liver cancer deaths in liver recipients (of which all deaths were from pretransplant diagnoses). CONCLUSIONS: Improved posttransplant prevention or screening for lung cancer, NHL, and skin cancers and management of liver recipients with prior liver cancer may reduce cancer mortality among recipients.

Polarized x-rays constrain the disk-jet geometry in the black hole x-ray binary Cygnus X-1.

A black hole x-ray binary (XRB) system forms when gas is stripped from a normal star and accretes onto a black hole, which heats the gas sufficiently to emit x-rays. We report a polarimetric observation of the XRB Cygnus X-1 using the Imaging X-ray Polarimetry Explorer. The electric field position angle aligns with the outflowing jet, indicating that the jet is launched from the inner x-ray-emitting region. The polarization degree is 4.01 ± 0.20% at 2 to 8 kiloelectronvolts, implying that the accretion disk is viewed closer to edge-on than the binary orbit. These observations reveal that hot x-ray-emitting plasma is spatially extended in a plane perpendicular to, not parallel to, the jet axis.

The impact of the Covid-19 pandemic in a polarized political system: Lessons from the 2020 election.

Given the deep polarization of the American political system in recent decades, was the 2020 presidential election an extension of the pre-existing partisan coalitions or did the Covid-19 pandemic and its economic consequences have a significant impact on the outcome? Using a national probability sample provided by AmeriSpeak and voter verification provided by Catalist, we construct a structural equation model to examine the relative influence of age, race, gender, education, religious fundamentalism, ideological partisanship, affective partisanship, and measures of Covid-19 experiences and understanding to predict the 2020 vote. We re-construct the partisan polarization landscape to examine the role of politically interested non-partisans in the center of the ideological spectrum and examine their ability to select candidates in response of specific issues. The Covid-19 pandemic had a significant marginal impact on the outcome of the 2020 presidential election.

Public attitude toward Covid-19 vaccination: The influence of education, partisanship, biological literacy, and coronavirus understanding.

The Covid-19 pandemic posed new issues about vaccination and contagious diseases that had not been the focus of public policy debate in the United States since the tuberculosis pandemic of the late 19th century and the early 20th century. Using a national address-based probability sample of American adults in 2020 and a structural equation model, this analysis seeks to understand the role of education, age, gender, race, education, partisanship, religious fundamentalism, biological literacy, and understanding of the coronavirus to predict individual intention concerning taking the Covid-19 vaccine. Given the substantial changes in the United States since the tuberculosis pandemic, it is important to understand the factors that drive acceptance and hesitancy about Covid-19 vaccination. We find that education, biological literacy, and understanding of the coronavirus were strong positive predictors of willingness to be vaccinated and religious fundamentalism and conservative partisanship were strong negative predictors of intent to vaccinate. These results should be encouraging to the scientific community.

Public understanding of science and technology in the Internet era.

When this journal was launched in 1992, there was a growing consensus among political and academic leaders that a broad understanding of science and technology was necessary for economic prosperity and democratic governance. This was more of an intuitive judgment than an empirical one. After 30 years of data collection and analysis, it appears that these early expectations were largely correct, but the value of the last three decades of social and psychological research is that we now have a firmer empirical basis for these beliefs and expectations. This essay outlines the impact of the growth of science and technology and the development of new information technologies that have changed the ways that individuals obtain information. I will discuss the implications of these changes for democracy in the 21st century.

Public acceptance of evolution in the United States, 1985-2020.

The public acceptance of evolution in the United States is a long-standing problem. Using data from a series of national surveys collected over the last 35 years, we find that the level of public acceptance of evolution has increased in the last decade after at least two decades in which the public was nearly evenly divided on the issue. A structural equation model indicates that increasing enrollment in baccalaureate-level programs, exposure to college-level science courses, a declining level of religious fundamentalism, and a rising level of civic scientific literacy are responsible for the increased level of public acceptance.

Dynamic Norming for Systematic Analysis of Language Transcripts.

PURPOSE: This exploratory study sought to establish the psychometric stability of a dynamic norming system using the Systematic Analysis of Language Transcripts (SALT) databases. Dynamic norming is the process by which clinicians select a subset of the normative database sample matched to their individual client's demographic characteristics. METHOD: The English Conversation and Student-Selected Story (SSS) Narrative databases from SALT were used to conduct the analyses in two phases. Phase 1 was an exploratory examination of the standard error of measure (SEM) of six clinically relevant transcript metrics at predetermined sampling intervals to determine (a) whether the dynamic norming process resulted in samples with adequate stability and (b) the minimum sample size required for stable results. Phase 2 was confirmatory, as random samples were taken from the SALT databases to simulate clinical comparison samples. These samples were examined (a) for stability of SEM estimations and (b) to confirm the sample size findings from Phase 1. RESULTS: Results of Phase 1 indicated that the SEMs for the six transcript metrics across both databases were low relative to each metric's scale. Samples as small as 40-50 children in the Conversation database and 20-30 children in the SSS Narrative database resulted in stable SEM estimations. Phase 2 confirmed these findings, indicating that age bands as small as ±4 months from a given center-point resulted in stable estimations provided there were approximately 35 children or more in the comparison sample. CONCLUSION: Psychometrically stable comparison samples can be achieved using SALT's dynamic norming system that are much smaller than the standard sample size recommended in most tests of children's language.

Diagnostic performance of a faecal immunochemical test for patients with low-risk symptoms of colorectal cancer in primary care: an evaluation in the South West of England.

BACKGROUND: The faecal immunochemical test (FIT) was introduced to triage patients with low-risk symptoms of possible colorectal cancer in English primary care in 2017, underpinned by little primary care evidence. METHODS: All healthcare providers in the South West of England (population 4 million) participated in this evaluation. 3890 patients aged ≥50 years presenting in primary care with low-risk symptoms of colorectal cancer had a FIT from 01/06/2018 to 31/12/2018. A threshold of 10 µg Hb/g faeces defined a positive test. RESULTS: Six hundred and eighteen (15.9%) patients tested positive; 458 (74.1%) had an urgent referral to specialist lower gastrointestinal (GI) services within three months. Forty-three were diagnosed with colorectal cancer within 12 months. 3272 tested negative; 324 (9.9%) had an urgent referral within three months. Eight were diagnosed with colorectal cancer within 12 months. Positive predictive value was 7.0% (95% CI 5.1-9.3%). Negative predictive value was 99.8% (CI 99.5-99.9%). Sensitivity was 84.3% (CI 71.4-93.0%), specificity 85.0% (CI 83.8-86.1%). The area under the ROC curve was 0.92 (CI 0.86-0.96). A threshold of 37 µg Hb/g faeces would identify patients with an individual 3% risk of cancer. CONCLUSIONS: FIT performs exceptionally well to triage patients with low-risk symptoms of colorectal cancer in primary care; a higher threshold may be appropriate in the wake of the COVID-19 crisis.

Testing The Lamp-Post and Wind Reverberation Models with XMM-Newton Observations of NGC 5506.

The lamp-post geometry is often used to model X-ray data of accreting black holes. Despite its simple assumptions, it has proven to be powerful in inferring fundamental black hole properties such as the spin. Early results of X-ray reverberations showed support for such a simple picture, though wind-reverberation models have also been shown to explain the observed delays. Here, we analyze new and old XMM-Newton observations of the variable Seyfert-1 galaxy NGC 5506 to test these models. The source shows an emission line feature around 6.7 keV that is delayed relative to harder and softer energy bands. The spectral feature can be modeled with either a weakly relativistic disk line or by scattering in distant material. By modeling both the spectral and timing signatures, we find that the reflection fraction needed to explain the lags is larger than observed in the time-averaged spectrum, ruling out both a static lamp-post and simple wind reverberation models.

The Affordable Care Act: Long-Term Financial Impact on a Level I Trauma Center.

BACKGROUND: Prior studies of the impact of the Affordable Care Act on reimbursement for inpatient trauma care do not include disproportionate share hospital (DSH) funding. Because trauma centers and other safety-net hospitals are sensitive to any changes in financial support, it is essential to include DSH funding in evaluating overall reimbursement. This study analyzes the long-term financial trends, including DSH, of a level I trauma center in Ohio, a state that expanded Medicaid. METHODS: Charges, reimbursement, sources of insurance coverage, Injury Severity Scores, and DSH funding for the trauma patient population of an Ohio American College of Surgeons level 1 trauma center were studied from 2012 to 2017. Data were collected from Transition Systems, Inc. RESULTS: During 2012-2017, self-pay patient cases decreased from 15.0% to 4.1% and commercial insurance patients decreased from 34.2% to 27.6%. The percentage of Medicaid patients increased from 15.5% to 27.1%; however, Medicaid reimbursement average per case declined from $17,779 in 2012 to $10,115 in 2017 (a decline of 43.1%). Self-pay charges decreased from $22.0 million to $6.7 million. Total DSH funding, compensation given to hospitals that disproportionately treat underserved populations, decreased 17.4%. CONCLUSIONS: Self-pay charges and self-pay patients decreased dramatically; Medicaid patients and charges increased substantially in the years after the implementation of the Affordable Care Act at our trauma center. However, there was a decrease in commercial insurance, which had the highest reimbursement for our hospital, and a significant decline in DSH, a critical supplemental source of funding for safety-net hospitals.

The impact of the Great Recession on the ability of parents to fund their children's college education.

In the United States, most families in the middle class or higher are expected to finance a significant portion of the cost of their children's college education. Using data from the Longitudinal Study of American Life (LSAL), we analyse the impact of the Great Recession (GR) on the beliefs about responsibility and plans of parents in their mid- to late thirties to finance the post-secondary education costs of their children. Results demonstrate that the GR was unrelated to parents' beliefs about their responsibility to finance their children's post-secondary education, but it was associated with their plans for financing it. Parents who experienced a positive net impact of the GR were more likely to report having a savings plan and being able to borrow money if needed. Parents who experienced a negative net impact of the GR were more likely to report that their child needed a grant, scholarship or loan. College-educated parents were more likely to believe that parents have primary responsibility for financing their children's education and to have a savings plan in place. However, parents who had had a student loan themselves and who had more children pursuing college were more likely to believe that parents have partial financial responsibility and that children should also contribute financially by getting grants, scholarships and loans.

The impact of the Great Recession on Generation X.

For people born in the 1960s and 1970s, sometimes known as Generation X, the Great Recession (GR) was the first major economic downturn that they have experienced. Using the 30+ year record of the Longitudinal Study of American Life (LSAL), this analysis examines the economic impact of the GR on an American cohort born in 1972-75 who were in their mid-40s in 2019. A confirmatory factor analysis index was constructed to summarise the economic experience of each LSAL participant in the period from 2007 (the eve of the GR) through 2014. Most of the LSAL participants did not experience negative economic consequences, but a significant subset of participants experienced substantial negative effects. A structural equation model (SEM) was used to estimate the relative influence of several educational and family variables on the nature and magnitude of the GR on employment and related economic issues. Educational attainment was the strongest predictor of the economic impact of the GR on individuals. The educational attainment of the parents of LSAL participants was the second strongest predictor, indicating the inherited advantages of social class. The impact of the GR on participants was unrelated to gender, but African-Americans were more likely to experience negative economic consequences from the GR than other young adults, holding constant differences in educational attainment, parent education attainment and other factors.

Multicontextual correlates of adolescent sugar-sweetened beverage intake.

PURPOSE: To examine personal, home, peer, school, neighborhood, and media correlates of sugar-sweetened beverage (SSB) intake in a diverse sample of adolescents. METHODS: Cross-sectional, population-based study (EAT 2010: Eating and Activity in Teens) of 2793 adolescents (54% female, mean age [SD] = 14.5 [2.0], 80% nonwhite) attending public secondary schools in Minneapolis-St. Paul, Minnesota. Adolescents completed a food frequency questionnaire and answered survey questions about their diet/health perceptions and behaviors. Socio-environmental data were collected from parents/caregivers, peers, school personnel, Geographic Information Systems (e.g., distance to food outlet), and a content analysis of favorite TV shows. Individual and mutually adjusted mixed-effects regression models examined associations between multi-contextual factors and estimated daily servings of SSB, controlling for relevant covariates. RESULTS: The contextual factors examined accounted for 24% of the variance in adolescents' SSB consumption. The proportion of variance explained by each context was 13% personal, 16% home/family, 3% peer, 1% school, 0.1% media, and 0% neighborhood. The strongest correlate of SSB intake was home soda availability (adjusted for covariates: ß = 0.26, p < 0.01; adjusted for all multi-contextual factors: ß = 0.18, p < 0.01). Other significant correlates of SSB intake included personal behaviors (e.g., fast food intake, sleep), home/family factors (e.g., parent modeling) and peer influences (e.g., friends' SSB intake). CONCLUSIONS: Public health policies and programs to reduce adolescent SSB intake should target personal behaviors (e.g., limit fast food, encourage adequate sleep), address the home setting (e.g., help parents to reduce SSB availability and model healthy eating habits) and involve peers (e.g., identify and enable peers to model healthy eating behaviors).

The response of relativistic outflowing gas to the inner accretion disk of a black hole.

The brightness of an active galactic nucleus is set by the gas falling onto it from the galaxy, and the gas infall rate is regulated by the brightness of the active galactic nucleus; this feedback loop is the process by which supermassive black holes in the centres of galaxies may moderate the growth of their hosts. Gas outflows (in the form of disk winds) release huge quantities of energy into the interstellar medium, potentially clearing the surrounding gas. The most extreme (in terms of speed and energy) of these-the ultrafast outflows-are the subset of X-ray-detected outflows with velocities higher than 10,000 kilometres per second, believed to originate in relativistic (that is, near the speed of light) disk winds a few hundred gravitational radii from the black hole. The absorption features produced by these outflows are variable, but no clear link has been found between the behaviour of the X-ray continuum and the velocity or optical depth of the outflows, owing to the long timescales of quasar variability. Here we report the observation of multiple absorption lines from an extreme ultrafast gas flow in the X-ray spectrum of the active galactic nucleus IRAS 13224-3809, at 0.236 ± 0.006 times the speed of light (71,000 kilometres per second), where the absorption is strongly anti-correlated with the emission of X-rays from the inner regions of the accretion disk. If the gas flow is identified as a genuine outflow then it is in the fastest five per cent of such winds, and its variability is hundreds of times faster than in other variable winds, allowing us to observe in hours what would take months in a quasar. We find X-ray spectral signatures of the wind simultaneously in both low- and high-energy detectors, suggesting a single ionized outflow, linking the low- and high-energy absorption lines. That this disk wind is responding to the emission from the inner accretion disk demonstrates a connection between accretion processes occurring on very different scales: the X-ray emission from within a few gravitational radii of the black hole ionizing the disk wind hundreds of gravitational radii further away as the X-ray flux rises.

Ultraluminous X-ray bursts in two ultracompact companions to nearby elliptical galaxies.

A flaring X-ray source was found near the galaxy NGC 4697 (ref. 1). Two brief flares were seen, separated by four years. During each flare, the flux increased by a factor of 90 on a timescale of about one minute. There is no associated optical source at the position of the flares, but if the source was at the distance of NGC 4697, then the luminosities of the flares were greater than 1039 erg per second. Here we report the results of a search of archival X-ray data for 70 nearby galaxies looking for similar flares. We found two ultraluminous flaring sources in globular clusters or ultracompact dwarf companions of parent elliptical galaxies. One source flared once to a peak luminosity of 9 × 1040 erg per second; the other flared five times to 1040 erg per second. The rise times of all of the flares were less than one minute, and the flares then decayed over about an hour. When not flaring, the sources appear to be normal accreting neutron-star or black-hole X-ray binaries, but they are located in old stellar populations, unlike the magnetars, anomalous X-ray pulsars or soft γ repeaters that have repetitive flares of similar luminosities.

Requirements for Pseudomonas aeruginosa Type I-F CRISPR-Cas Adaptation Determined Using a Biofilm Enrichment Assay.

CRISPR (clustered regularly interspaced short palindromic repeat)-Cas (CRISPR-associated protein) systems are diverse and found in many archaea and bacteria. These systems have mainly been characterized as adaptive immune systems able to protect against invading mobile genetic elements, including viruses. The first step in this protection is acquisition of spacer sequences from the invader DNA and incorporation of those sequences into the CRISPR array, termed CRISPR adaptation. Progress in understanding the mechanisms and requirements of CRISPR adaptation has largely been accomplished using overexpression of cas genes or plasmid loss assays; little work has focused on endogenous CRISPR-acquired immunity from viral predation. Here, we developed a new biofilm-based assay system to enrich for Pseudomonas aeruginosa strains with new spacer acquisition. We used this assay to demonstrate that P. aeruginosa rapidly acquires spacers protective against DMS3vir, an engineered lytic variant of the Mu-like bacteriophage DMS3, through primed CRISPR adaptation from spacers present in the native CRISPR2 array. We found that for the P. aeruginosa type I-F system, the cas1 gene is required for CRISPR adaptation, recG contributes to (but is not required for) primed CRISPR adaptation, recD is dispensable for primed CRISPR adaptation, and finally, the ability of a putative priming spacer to prime can vary considerably depending on the specific sequences of the spacer. IMPORTANCE: Our understanding of CRISPR adaptation has expanded largely through experiments in type I CRISPR systems using plasmid loss assays, mutants of Escherichia coli, or cas1-cas2 overexpression systems, but there has been little focus on studying the adaptation of endogenous systems protecting against a lytic bacteriophage. Here we describe a biofilm system that allows P. aeruginosa to rapidly gain spacers protective against a lytic bacteriophage. This approach has allowed us to probe the requirements for CRISPR adaptation in the endogenous type I-F system of P. aeruginosa Our data suggest that CRISPR-acquired immunity in a biofilm may be one reason that many P. aeruginosa strains maintain a CRISPR-Cas system.