Entanglement entropy and hyperuniformity of Ginibre and Weyl-Heisenberg ensembles.

We show that, for a class of planar determinantal point processes (DPP) X, the growth of the entanglement entropy S(X(Ω)) of X on a compact region Ω⊂R2d, is related to the variance VX(Ω) as follows: VX(Ω)≲SX(Ω)≲VX(Ω).Therefore, such DPPs satisfy an area law SXg(Ω)≲∂Ω, where ∂Ω is the boundary of Ω if they are of Class I hyperuniformity (VX(Ω)≲∂Ω), while the area law is violated if they are of Class II hyperuniformity (as L→∞, VX(LΩ)∼CΩLd-1logL). As a result, the entanglement entropy of Weyl-Heisenberg ensembles (a family of DPPs containing the Ginibre ensemble and Ginibre-type ensembles in higher Landau levels), satisfies an area law, as a consequence of its hyperuniformity.

A Qualitative Assessment of the Multimodal Passenger Transportation System Response to COVID-19 in New York City.

This paper presents a qualitative analysis of transportation system changes that occurred in New York City (NYC) from the beginning of the COVID-19 pandemic until the city began its first phase of reopening in June 2020. The study was conducted by tracking publicly available transportation-related news articles and publications, 1) to capture key issues and challenges and 2) to identify changes in policies, services, and infrastructure that occurred in response across five passenger transportation modes: public transit; taxis; ridesharing; personal driving; and cycling and micromobility. Results were assessed to identify common issues and interactions between modes. The paper concludes with key lessons learned from this event, and recommendations for future policy.

Abnormal Eye and Cranial Movements Triggered by Examination in People with Functional Neurological Disorder.

The diagnosis of functional neurological disorder (FND) relies on the demonstration of positive symptoms and signs, as supported by recent changes in DSM5. We recorded the findings of routine clinical eye movement assessment in 101 consecutive new patients with FND. Clinical examination triggered facial and eye movement disorders in 46% of patients, all with positive characteristics of functional movement disorder. These are useful as supporting features in making a positive diagnosis of FND.

Jejunitis secondary to Duodopa® probe, a different complication.

Treatment with continuous infusion of intraduodenal (Duodopa®) levodopa / carbidopa is indicated in patients with advanced Parkinson's disease who have not responded to conventional treatment. We present here the case of a patient with this type of probe that debuted jejunitis. A distal phytobezoar was the main causal agent. This rare complication may be favored in cases of intestinal hypomotility. Treatment involves its withdrawal as soon as possible and replacement by a new probe, which results in healing.

[Impact of the incorporation of a nurse in an inflammatory bowel disease unit]. / Impacto de la incorporación de la enfermera a una unidad de enfermedad inflamatoria intestinal.

INTRODUCTION: Multidisciplinary units are needed because of the growing complexity and volume of patients with inflammatory bowel disease (IBD). OBJECTIVES: To evaluate the healthcare, economic and research impact of incorporating a nurse into the IBD unit of the Puerta de Hierro Majadahonda University Hospital. METHODS: We prospectively recorded the activity carried out by the nurse of the IBD unit from March 2010 to December 2014. RESULTS: During this period, healthcare demand progressively increased, with 1,558 patients being attended by our unit. The healthcare provided by the nurse included 5,293 electronic mails and 678 telephone calls. We estimated that this activity represented a saving of 3,504 in-person medical consultations and 852 accident and emergency department visits. Other activities consisted of monitoring treatments with biological and non-biological agents (8,371 laboratory tests), extraction of 342 blood samples, follow-up of 1047 diagnostic tests and consultations with other medical specialties, health education in self-administration of drugs in 114 patients, the performance of 158 granulocyte apheresis procedures, and participation in 25 research projects. CONCLUSION: The incorporation of a specialised nurse in an IBD unit had major economic, healthcare and research benefits.

A randomized trial to compare the efficacy and tolerability of sodium picosulfate-magnesium citrate solution vs. 4 L polyethylene glycol solution as a bowel preparation for colonoscopy.

PURPOSE: The purpose of this study is to compare the efficacy and acceptability of an evening-before regimens of sodium picosulfate/magnesium citrate (SPMC) and polyethylene glycol (PEG) as bowel cleansers and to explore the results of a same-day regimen of SPMC. METHODS: Multicenter, randomized, observer-blinded, parallel study carried out in subjects who were 18-80 years old and were undergoing diagnostic colonoscopy for the first time. The primary outcome was treatment success, which was a composite outcome defined by (1) the evaluation of the overall preparation quality as "excellent" or "good" by two blinded independent evaluators with the Fleet(®) Grading Scale for Bowel Cleansing and (2) a subject's acceptability rating of "easy to take" or "tolerable." The primary outcome was analyzed using a logistic regression with site, gender, and age group (age ≥65 years and <65 years) as factors. RESULTS: Four hundred ninety subjects were included in the efficacy evaluation. Although treatment success was significantly higher in subjects assigned to the evening-before regimen of SPMC vs. subjects assigned to the evening-before PEG, when evaluating the two individual components for treatment success, there were significant differences in the ease of completion but not in the quality of preparation. The same-day SPMC regimen was superior to both the evening-before regimen of SPMC and PEG in terms of the quality of preparation, especially regarding the proximal colon. CONCLUSIONS: An evening-before regimen of SPMC is superior to an evening-before regimen of PEG in terms of subject's acceptability. The same-day SPMC regimen provides better cleansing levels in the proximal colon.

Impact of endoscopic monitoring in postoperative Crohn's disease patients already receiving pharmacological prevention of recurrence.

BACKGROUND: Current guidelines address the initiation of treatment to prevent postoperative recurrence (PR) after ileo-cecal resection in Crohn's disease (CD), but appropriate management of postoperative CD patients who are already receiving treatment to prevent PR is yet to be defined. Usefulness of endoscopic monitoring in this scenario remains uncertain. AIMS: To evaluate the usefulness of endoscopy-based management of postoperative CD patients who are already under pharmacological prevention of PR. METHODS: Retrospective review of clinical outcome of all CD patients with ileo-cecal resection who underwent postoperative colonoscopy between 2004 and 2013 at our centre. Postoperative endoscopic findings were classified as no endoscopic recurrence (Rutgeerts i0-i1) or endoscopic recurrence (Rutgeerts i2-i4). Patients with endoscopic recurrence were classified as "endoscopy-based management (EBM)" if treatment step-up after endoscopy, or "non EBM (N-EBM)". Clinical recurrence was considered if re-operation, CD related hospitalization or treatment change. Time until clinical recurrence or the end of the follow up was considered. RESULTS: One hundred sixty six patients initially identified. One hundred twenty nine (77%) under pharmacological prevention of PR at the time of colonoscopy were analyzed: 34% were receiving aminosalicylates, 50% thiopurines, 11% anti-TNF, 5% combo. Colonoscopy showed endoscopic recurrence in 57% of patients; those with N-EBM were more likely to have clinical recurrence than patients with EBM along the follow up (p = 0.01). Conclussions: Endoscopic monitoring could be useful in postoperative CD patients also in patients already receiving pharmacological treatment to prevent PR.

Mucosal healing in Crohn's disease: relevance and controversies in real life clinical practice.

Mucosal healing is a recent and emerging concept in Crohn's disease management that has been associated to a good prognosis and therefore it has been also proposed to be a clinically relevant therapeutic endpoint. On the other hand, there are many controversial aspects about this concept, and some clinically relevant difficulties that may preclude clinicians from moving this concept from clinical trials to clinical practice in many cases. This review is focused on both aspects of mucosal healing in day-to-day real life clinical practice.

Perceiving greater variety among past conflicts with a focal goal reduces expected goal conflict.

Many important personal goals, such as health, career, finances, and social relationships, entail repeatedly performing the same (or similar) actions over time (e.g., to exercise daily or save money weekly). When pursuing such ongoing goals, people are likely to accumulate multiple experiences of goal conflict (e.g., multiple occasions when one failed to exercise or save as intended). How might these past experiences of goal conflict inform expectations about future goal pursuit? This research examines how the perceived relationship among past conflicts with a focal goal-in particular, perceived variety-shapes expectations. Perceived variety refers to the holistic assessment of differentiation (vs. similarity) among items in an assortment. Six studies demonstrate that perceiving greater variety among past conflicts with a focal goal decreases expectations of encountering conflict in the future. This occurs because perceiving greater variety makes the causes of past events seem collectively unstable (i.e., more temporary and one-off). Consequently, holding constant the number and content of past events, perceiving greater variety among past conflicts with a focal goal reduces expected goal conflict. Further, considering past events that prompt (i.e., motivate) less (vs. more) engagement in causal search (i.e., events that are less self-relevant, or positive) attenuates perceived variety's effects. The findings contribute to understanding of goal conflict, variety and similarity, and forecasting in goal pursuit. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Closing the Gap: A Case Report on a Blood Patch Solution for Cerebrospinal Fluid Leak.

Spontaneous intracranial hypotension is a condition resulting from cerebrospinal fluid leaks at the spinal level that disrupt the regulation of intracranial pressure. This disorder is an uncommon cause of debilitating headaches but can have variable clinical manifestations, which contributes to delayed diagnosis and potentially severe consequences. The standard treatment consists of conservative measures such as bed rest, hydration, and a pharmacological approach with paracetamol, caffeine, ergotamine, and dexamethasone. When conservative measures fail, an epidural blood patch is the gold standard treatment, where a small amount of blood is injected into the epidural space to form a clot to seal any existing leak. Recent studies showed a success rate of 64% without the need for further intervention. The authors report a case of a 55-year-old woman with a three-month history of daily severe headaches. Imaging exams showed subdural collections, suggesting the hypothesis of cerebrospinal fluid hypotension. After the failure of conservative measures, an epidural blood patch was performed with progressive clinical improvement.  This case demonstrates the potential effectiveness of an epidural blood patch in the management of spontaneous intracranial hypotension and its complications, offering an encouraging option for those unresponsive to conservative measures. It also highlights the importance of a multidisciplinary approach involving neurologists and anesthesiologists.

Using of magnetic resonance enterography in the management of Crohn's disease of the small intestine: first year of experience.

OBJECTIVE: to describe the experience at two tertiary centres during the first year of use of magnetic resonance enterography (MRE) for the management of Crohn's disease (CD): indications and influence of the technique in clinical decision making. MATERIALS AND METHODS: retrospective descriptive study in which patients who underwent MRE were included consecutively. Epidemiological and clinical data were collected from the patients, as well as the indication for the study and how it influenced clinical decision making in the 10 days following the radiological study. RESULTS: 24 MREs were performed in suspected CD and 126 known CD; partial bowel obstruction in 53 patients (42%), monitoring of medical treatment in 34 (27%), due to incomplete ileocolonoscopy in 16 (13%), extension study of the small intestine in 15 (12%) and suspected complicated CD in 8 patients (6%). The MRE influenced in a change in treatment in 83 (55.3%) patients: 16 (10.7%) started with immunosuppressants, 41 (27.3%) with anti-TNFα were started on or switched, 15 (10%) were ordered surgery and in 3 (2%) changed from combined therapy to monotherapy. The MRE had less influence on clinical decision making in the group in which the indication was suspected CD (p < 0.05). CONCLUSIONS: the use of MRE helped on decision making in more than half of patients, especially with regards to decisions related to the use of biological therapies and the indication for surgery. MRE was less useful in suspected CD patients.

Isolated pulmonary valve endocarditis in a normal heart.

Isolated pulmonary valve endocarditis is a very rare entity, usually associated with intravenous drug abuse. We describe a case of isolated pulmonary valve endocarditis in a diabetic patient with no apparent precipitating factors besides a lesion on the right hallux. The clinical course was favorable and he was discharged home after a six-week course of antibiotic therapy.

Trends and Predictors of Imaging Utilization by Modality within an Academic Health System's Active Patient Population.

RATIONALE AND OBJECTIVES: Evaluate trends and demographic predictors of imaging utilization at a university-affiliated health system. MATERIALS AND METHODS: In this single-institution retrospective study, per capita estimates of imaging utilization among patients active in the health system were computed by cross-referencing all clinical encounters (2004-2016) for 1,628,980 unique patients with a listing of 6,157,303 diagnostic radiology encounters. Time trends in imaging utilization and effects of gender, race/ethnicity, and age were assessed, with subgroup analyses performed by imaging modality. Utilization was analyzed as both a continuous and binary outcome variable. RESULTS: Over 13 years, total diagnostic exams rose 6.8% a year (285,947-622,196 exams per annum), while the active population size grew 7.0% a year (244,238-543,290 active patients per annum). Per capita utilization peaked in 2007 at 1.33 studies/patient/year before dropping to 1.06 from 2011 to 2015. Latest per capita utilization was 0.22 for computed tomography, 0.10 for MR, 0.20 for US, 0.03 for NM, 0.51 for radiography, and 0.07 for mammography. Over the study period, ultrasound utilization doubled, whereas NM and radiography utilization decreased. computed tomography, MR, and mammography showed no significant net change. Univariate analysis of utilization as a continuous variable showed statistically significant effects of gender, race/ethnicity, and age (P < 0.0001), with utilization higher in males and Blacks and lower in Asian/Pacific Islanders and Hispanics. Utilization increased with age, except for a decline after age 75. Many of the effects of age, gender, and race/ethnicity were also found when analyzing the binarized utilization variable. CONCLUSIONS: Although absolute counts of imaging studies more than doubled, the net change in per capita utilization over the study period was minimal. Variations in utilization across age, gender, and race/ethnicity may reflect differential health needs and/or access disparities, warranting future studies.

Internode elongation in energy cane shows remarkable clues on lignocellulosic biomass biosynthesis in Saccharum hybrids.

Energy cane is a dedicated crop to high biomass production and selected during Saccharum breeding programs to fit specific industrial needs for 2G bioethanol production. Internode elongation is one of the most important characteristics in Saccharum hybrids due to its relationship with crop yield. In this study, we selected the third internode elongation of the energy cane. To characterize this process, we divided the internode into five sections and performed a detailed transcriptome analysis (RNA-Seq) and cell wall characterization. The histological analyses revealed a remarkable gradient that spans from cell division and protoxylem lignification to the internode maturation and complete vascular bundle lignification. RNA-Seq analysis revealed more than 11,000 differentially expressed genes between the sections internal. Gene ontology analyzes showed enriched categories in each section, as well as the most expressed genes in each section, presented different biological processes. We found that the internode elongation and division zones have a large number of unique genes. Evaluated the specific profile of genes related to primary and secondary cell wall formation, cellulose synthesis, hemicellulose, lignin, and growth-related genes. For each section these genes presented different profiles along the internode in elongation in energy cane. The results of this study provide an overview of the regulation of gene expression of an internode elongation in energy cane. Gene expression analysis revealed promising candidates for transcriptional regulation of energy cane lignification and evidence key genes for the regulation of internode development, which can serve as a basis for understanding the molecular regulatory mechanisms that support the growth and development of plants in the Saccahrum complex.

Patient disease perceptions and coping strategies for arthritis in a developing nation: a qualitative study.

BACKGROUND: There is little prior research on the burden of arthritis in the developing world. We sought to document how patients with advanced arthritis living in the Dominican Republic are affected by and cope with their disease. METHODS: We conducted semi-structured, one-to-one interviews with economically disadvantaged Dominican patients with advanced knee and/or hip arthritis in the Dominican Republic. The interviews, conducted in Spanish, followed a moderator's guide that included topics such as the patients' understanding of disease etiology, their support networks, and their coping mechanisms. The interviews were audiotaped, transcribed verbatim in Spanish, and systematically analyzed using content analysis. We assessed agreement in coding between two investigators. RESULTS: 18 patients were interviewed (mean age 60 years, median age 62 years, 72% women, 100% response rate). Patients invoked religious and environmental theories of disease etiology, stating that their illness had been caused by God's will or through contact with water. While all patients experienced pain and functional limitation, the social effects of arthritis were gender-specific: women noted interference with homemaking and churchgoing activities, while men experienced disruption with occupational roles. The coping strategies used by patients appeared to reflect their beliefs about disease causation and included prayer and avoidance of water. CONCLUSIONS: Patients' explanatory models of arthritis influenced the psychosocial effects of the disease and coping mechanisms used. Given the increasing reach of global health programs, understanding these culturally influenced perceptions of disease will be crucial in successfully treating chronic diseases in the developing world.

Adalimumab is effective in long-term real life clinical practice in both luminal and perianal Crohn's disease. The Madrid experience.

OBJECTIVE: To evaluate effectiveness and safety of adalimumab in CD patients of the Madrid area and identify predictors of response. METHODS: Multicenter retrospective survey of all CD patients treated with adalimumab in 9 hospitals of the Madrid area (Spain). Univariate and multivariate analysis of predictors of response was performed. RESULTS: 174 patients included (50% males) with a median follow-up of 40 weeks. 30% had active perianal fistulizing disease at the beginning of the therapy with adalimumab. 59% had been previously treated with infliximab, being the lost of response (42.2%) the most frequent cause of withdrawal of the drug. 33% of patients needed dose escalation from every-other week to every week. The median time for this dose escalation was 33 weeks (range 2-120). The percentages of complete response at 4 weeks, 6 months and end of follow-up were 63, 70 and 63% in luminal disease and 49, 50 and 41% in perianal disease respectively. The prevalence of adverse events was 18% (most frequent was: 5 abscesses) causing the withdrawal of the drug in 21% of them. CONCLUSIONS: Adalimumab is effective and safe for the management of CD, even in refractory cases to infliximab.