Cholesteatoma and family history: An international survey

Objective To explore the relative frequency of a family history of cholesteatoma in patients with known cholesteatoma, and whether bilateral disease or earlier diagnosis is more likely in those with a family history. Associations between cleft lip or palate and bilateral disease and age of diagnosis were also explored. Design An online survey of patients with diagnosed cholesteatoma was conducted between October 2017 and April 2019. Participants The sample consisted of patients recruited from two UK clinics and self‐selected respondents recruited internationally via social media. Main outcome measures Side of cholesteatoma, whether respondents had any family history of cholesteatoma, age of diagnosis and personal or family history of cleft lip or palate were recorded. Results Of 857 respondents, 89 (10.4%) reported a positive family history of cholesteatoma. Respondents with a family history of cholesteatoma were more likely to have bilateral cholesteatoma (P = .001, odds ratio (OR) 2.15, 95% confidence interval (CI) 1.35‐3.43), but there was no difference in the age of diagnosis (P = .23). Those with a history of cleft lip or palate were not more likely to have bilateral disease (P = .051, OR 2.71, CI 1.00‐7.38), and there was no difference in age of diagnosis (P = .11). Conclusion The relatively high proportion of respondents that reported a family history of cholesteatoma offers supporting evidence of heritability in cholesteatoma. The use of social media to recruit respondents to this survey means that the results cannot be generalised to other populations with cholesteatoma. Further population‐based research is suggested to determine the heritability of cholesteatoma

Inter-comparison of relative stopping power estimation models for proton therapy

Theoretical stopping power values were inter-compared for the Bichsel, Janni, ICRU and Schneider relative stopping power (RSP) estimation models, for a variety of tissues and tissue substitute materials taken from the literature. The RSPs of eleven plastic tissue substitutes were measured using Bragg peak shift measurements in water in order to establish a gold standard of RSP values specific to our centre's proton beam characteristics. The theoretical tissue substitute RSP values were computed based on literature compositions to assess the four different computation approaches. The Bichsel/Janni/ICRU approaches led to mean errors in the RSP of  −0.1/+0.7/−0.8%, respectively. Errors when using the Schneider approach, with I-values from the Bichsel, Janni and ICRU sources, followed the same pattern but were generally larger. Following this, the mean elemental ionisation energies were optimized until the differences between theoretical RSP values matched measurements. Failing to use optimized I-values when applying the Schneider technique to 72 human tissues could introduce errors in the RSP of up to  −1.7/+1.1/−0.4% when using Bichsel/Janni/ICRU I-values, respectively. As such, it may be necessary to introduce an additional step in the current stoichiometric calibration procedure in which tissue insert RSPs are measured in a proton beam. Elemental I-values can then optimized to match these measurements, reducing the uncertainty when calculating human tissue RSPs

Polynomial Interrupt Timed Automata

Interrupt Timed Automata (ITA) form a subclass of stopwatch automata where reachability and some variants of timed model checking are decidable even in presence of parameters. They are well suited to model and analyze real-time operating systems. Here we extend ITA with polynomial guards and updates, leading to the class of polynomial ITA (PolITA). We prove the decidability of the reachability and model checking of a timed version of CTL by an adaptation of the cylindrical decomposition method for the first-order theory of reals. Compared to previous approaches, our procedure handles parameters and clocks in a unified way. Moreover, we show that PolITA are incomparable with stopwatch automata. Finally additional features are introduced while preserving decidability

Maximizing ENSO as a source of western US hydroclimate predictability

Until recently, the El Niño–Southern Oscillation (ENSO) was considered a reliable source of winter precipitation predictability in the western US, with a historically strong link between extreme El Niño events and extremely wet seasons. However, the 2015–2016 El Niño challenged our understanding of the ENSO-precipitation relationship. California precipitation was near-average during the 2015–2016 El Niño, which was characterized by warm sea surface temperature (SST) anomalies of similar magnitude compared to the extreme 1997–1998 and 1982–1983 El Niño events. We demonstrate that this precipitation response can be explained by El Niño’s spatial pattern, rather than internal atmospheric variability. In addition, observations and large-ensembles of regional and global climate model simulations indicate that extremes in seasonal and daily precipitation during strong El Niño events are better explained using the ENSO Longitude Index (ELI), which captures the diversity of ENSO’s spatial patterns in a single metric, compared to the traditional Niño3.4 index, which measures SST anomalies in a fixed region and therefore fails to capture ENSO diversity. The physically-based ELI better explains western US precipitation variability because it tracks the zonal shifts in tropical Pacific deep convection that drive teleconnections through the response in the extratropical wave-train, integrated vapor transport, and atmospheric rivers. This research provides evidence that ELI improves the value of ENSO as a predictor of California’s seasonal hydroclimate extremes compared to traditional ENSO indices, especially during strong El Niño events

Towards Precision Medicine in the Clinic: From Biomarker Discovery to Novel Therapeutics.

Precision medicine continues to be the benchmark to which we strive in cancer research. Seeking out actionable aberrations that can be selectively targeted by drug compounds promises to optimize treatment efficacy and minimize toxicity. Utilizing these different targeted agents in combination or in sequence may further delay resistance to treatments and prolong antitumor responses. Remarkable progress in the field of immunotherapy adds another layer of complexity to the management of cancer patients. Corresponding advances in companion biomarker development, novel methods of serial tumor assessments, and innovative trial designs act synergistically to further precision medicine. Ongoing hurdles such as clonal evolution, intra- and intertumor heterogeneity, and varied mechanisms of drug resistance continue to be challenges to overcome. Large-scale data-sharing and collaborative networks using next-generation sequencing (NGS) platforms promise to take us further into the cancer 'ome' than ever before, with the goal of achieving successful precision medicine

From the Community to the Clinic: Building Community Health Worker-Inclusive Healthcare Teams

Multidisciplinary clinical teams with strong community linkages can engage with patient needs and address the social determinants of health. Community Health Workers (CHWs) have emerged as one such embodiment of this cultural shift in improving delivery and coordination of care to reach patient communities. However, misunderstandings of CHWs’ contributions have limited their uptake into clinical teams. In partnership with the Southwestern Area Health Education Center, this project investigated the context and perspectives of CHW engagement in Connecticut, focusing barriers and facilitators of CHW integration into clinical teams. Through experimentation, innovation, and mutual learning, integrated, CHW-inclusive healthcare teams can begin taking the necessary steps to bridge the divide between the community and the clinic. Commitment to service should be meaningfully considered in the CHW hiring process. Being altruistic, compassionate, nonjudgmental, and service-oriented are important attributes facilitating camaraderie and trust within healthcare teams, while also enhancing CHWs’ long-term commitments to organizations. Purposively seeking out these traits during the onboarding process can foster a team dynamic anchored by CHWs mutual commitment to serving and connecting with patients. Organizations should foster mutual understanding and respect for the varied roles CHWs play. Clearly defining roles and responsibilities and demonstrating the value that CHWs bring outside of the context of clinical care can improve collaboration, encourage skills-sharing, and promote an organizational climate of respect. Organizational decision-makers should increase the visibility of CHWs and include CHWs in conversations and meetings with other clinical team members where added value can be consistently demonstrated and where mutual learning and collaboration can meaningfully occur. Healthcare organizations should critically consider how to holistically support the CHW workforce. Organizational levers that promote retention, mutual learning, networking, and management of job stress amongst CHWs can improve their ability to function effectively and contribute to a diverse team culture. The fact that CHWs not only navigate the disparate worlds of the community and the clinic but also endure the stress of managing complex intra- and extra-organizational relationships should be recognized, valued, and appreciated by organizational leadership.https://elischolar.library.yale.edu/ysph_pbchrr/1049/thumbnail.jp

Byzantine Gathering in Networks

This paper investigates an open problem introduced in [14]. Two or more mobile agents start from different nodes of a network and have to accomplish the task of gathering which consists in getting all together at the same node at the same time. An adversary chooses the initial nodes of the agents and assigns a different positive integer (called label) to each of them. Initially, each agent knows its label but does not know the labels of the other agents or their positions relative to its own. Agents move in synchronous rounds and can communicate with each other only when located at the same node. Up to f of the agents are Byzantine. A Byzantine agent can choose an arbitrary port when it moves, can convey arbitrary information to other agents and can change its label in every round, in particular by forging the label of another agent or by creating a completely new one. What is the minimum number M of good agents that guarantees deterministic gathering of all of them, with termination? We provide exact answers to this open problem by considering the case when the agents initially know the size of the network and the case when they do not. In the former case, we prove M=f+1 while in the latter, we prove M=f+2. More precisely, for networks of known size, we design a deterministic algorithm gathering all good agents in any network provided that the number of good agents is at least f+1. For networks of unknown size, we also design a deterministic algorithm ensuring the gathering of all good agents in any network but provided that the number of good agents is at least f+2. Both of our algorithms are optimal in terms of required number of good agents, as each of them perfectly matches the respective lower bound on M shown in [14], which is of f+1 when the size of the network is known and of f+2 when it is unknown

Quark initiated coherent diffractive production of muon pair and W boson at hadron colliders

The large transverse momentum muon pair and W boson productions in the quark initiated coherent diffractive processes at hadron colliders are discussed under the framework of the two-gluon exchange parametrization of the Pomeron model. In this approach, the production cross sections are related to the small-x off-diagonal gluon distribution and the large-x quark distribution in the proton (antiproton). By approximating the off-diagonal gluon distribution by the usual gluon distribution function, we estimate the production rates of these processes at the Fermilab Tevatron.Comment: 11pages, 6 PS figures, to appear in PR