Dietary guideline adherence for gastroesophageal reflux disease.

BackgroundGastroesophageal reflux disease (GERD) is the most common gastrointestinal disease, and the cost of health care and lost productivity due to GERD is extremely high. Recently described side effects of long-term acid suppression have increased the interest in nonpharmacologic methods for alleviating GERD symptoms. We aimed to examine whether GERD patients follow recommended dietary guidelines, and if adherence is associated with the severity and frequency of reflux symptoms.MethodsWe conducted a population-based cross-sectional study within the Kaiser Permanente Northern California population, comparing 317 GERD patients to 182 asymptomatic population controls. All analyses adjusted for smoking and education.ResultsGERD patients, even those with moderate to severe symptoms or frequent symptoms, were as likely to consume tomato products and large portion meals as GERD-free controls and were even more likely to consume soft drinks and tea [odds ratio (OR) = 2.01 95% confidence interval (CI) 1.12-3.61; OR = 2.63 95% CI 1.24-5.59, respectively] and eat fried foods and high fat diet. The only reflux-triggering foods GERD patients were less likely to consume were citrus and alcohol [OR = 0.59; 95% CI: 0.35-0.97 for citrus; OR = 0.41 95% CI 0.19-0.87 for 1 + drink/day of alcohol]. The associations were similar when we excluded users of proton pump inhibitors.ConclusionsGERD patients consume many putative GERD causing foods as frequently or even more frequently than asymptomatic patients despite reporting symptoms. These findings suggest that, if dietary modification is effective in reducing GERD, substantial opportunities for nonpharmacologic interventions exist for many GERD patients

Reducing Variation in the “Standard of Care” for Cancer Screening

Standard of care for cancer screening: the term implies certainty and consensus. Physicians, patients, and organizations have created guidelines, policies, and regulations regarding how, when, and for whom screening should be used or reimbursed; cumulatively, these statements become the standards of care. However, these standards vary markedly across organ type, often without rationale or evidence. In this Viewpoint, we highlight 3 areas in which cancer screening standards differ markedly for breast, colorectal, and cervical cancer: funding, quality measures, and reporting. These variations were delineated through a cross-disciplinary collaboration among scientists, health care organizations, and society leaders within the National Cancer Institute’s (NCI’s) Population-Based Research Optimizing Screening Through Personalized Regimens (PROSPR) consortium.1 PROSPR studies how breast, cervical, and colorectal cancer screening is implemented in diverse, real-world settings

Oral Bisphosphonate Exposure and the Risk of Upper Gastrointestinal Cancers

The association between oral bisphosphonate use and upper gastrointestinal cancer has been controversial. Therefore, we examined the association with esophageal and gastric cancer within the Kaiser Permanente, Northern California population. A total of 1,011 cases of esophageal (squamous cell carcinoma and adenocarcinoma) and 1,923 cases of gastric adenocarcinoma (cardia, non-cardia and other) diagnosed between 1997 and 2011 from the Kaiser Permanente, Northern California cancer registry were matched to 49,886 and 93,747 controls, respectively. Oral bisphosphonate prescription fills at least one year prior to the index date were extracted. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between prospectively evaluated oral bisphosphonate use with incident esophageal and gastric cancer diagnoses with adjustment for potential confounders. After adjustment for potential confounders, no significant associations were found for esophageal squamous cell carcinoma (OR 0.88; 95% CI: 0.51, 1.52), esophageal adenocarcinoma (OR 0.68; 95% CI: 0.37, 1.24), or gastric non-cardia adenocarcinoma (OR 0.83, 95% CI: 0.59, 1.18), but we observed an adverse association with gastric cardia adenocarcinoma (OR 1.64; 95% CI: 1.07, 2.50). In conclusion, we observed no association between oral bisphosphonate use and esophageal cancer risk within a large community-based population. A significant association was detected with gastric cardia and other adenocarcinoma risk, although this needs to be replicated

Approaches for classifying the indications for colonoscopy using detailed clinical data

BACKGROUND: Accurate indication classification is critical for obtaining unbiased estimates of colonoscopy effectiveness and quality improvement efforts, but there is a dearth of published systematic classification approaches. The objective of this study was to evaluate the effects of data-source and adjudication on indication classification and on estimates of the effectiveness of screening colonoscopy on late-stage colorectal cancer diagnosis risk. METHODS: This was an observational study in members of four U.S. health plans. Eligible persons (n = 1039) were age 55-85 and had been enrolled for 5 years or longer in their health plans during 2006-2008. Patients were selected based on late-stage colorectal cancer diagnosis in a case-control design; each case patient was matched to 1-2 controls by study site, age, sex, and health plan enrollment duration. Reasons for colonoscopies received in the 10-year period before the reference date were collected from three medical records sources (progress notes; referral notes; procedure reports) and categorized using an algorithm, with committee adjudication of some tests. We evaluated indication classification concordance before and after adjudication and used logistic regressions with the Wald Chi-square test to compare estimates of the effects of screening colonoscopy on late-stage colorectal cancer diagnosis risk for each of our data sources to the adjudicated indication. RESULTS: Classification agreement between each data-source and adjudication was 78.8-94.0% (weighted kappa = 0.53-0.72); the highest agreement (weighted kappa = 0.86-0.88) was when information from all data sources was considered together. The choice of data-source influenced the association between screening colonoscopy and late-stage colorectal cancer diagnosis; estimates based on progress notes were closest to those based on the adjudicated indication (% difference in regression coefficients = 2.4%, p-value = 0.98), as compared to estimates from only referral notes (% difference in coefficients = 34.9%, p-value = 0.12) or procedure reports (% difference in coefficients = 27.4%, p-value = 0.23). CONCLUSION: There was no single gold-standard source of information in medical records. The estimates of colonoscopy effectiveness from progress notes alone were the closest to estimates using adjudicated indications. Thus, the details in the medical records are necessary for accurate indication classification

Bosonization of non-relativstic fermions in 2-dimensions and collective field theory

We revisit bosonization of non-relativistic fermions in one space dimension. Our motivation is the recent work on bubbling half-BPS geometries by Lin, Lunin and Maldacena (hep-th/0409174). After reviewing earlier work on exact bosonization in terms of a noncommutative theory, we derive an action for the collective field which lives on the droplet boundaries in the classical limit. Our action is manifestly invariant under time-dependent reparametrizations of the boundary. We show that, in an appropriate gauge, the classical collective field equations imply that each point on the boundary satisfies Hamilton's equations for a classical particle in the appropriate potential. For the harmonic oscillator potential, a straightforward quantization of this action can be carried out exactly for any boundary profile. For a finite number of fermions, the quantum collective field theory does not reproduce the results of the exact noncommutative bosonization, while the latter are in complete agreement with the results computed directly in the fermi theory.Comment: references added and typos corrected; 21 pages, 3 figures, eps

Moduli Space Metric of N=2 Supersymmetric SU(N) Gauge Theory and the Enhancon

We compute the moduli space metric of SU(N) Yang-Mills theory with N=2 supersymmetry in the vicinity of the point where the classical moduli vanish. This gauge theory may be realized as a set of N D7-branes wrapping a K3 surface, near the enhancon locus. The moduli space metric determines the low-energy worldvolume dynamics of the D7 branes near this point, including stringy corrections. Non-abelian gauge symmetry is not restored on the worldvolume at the enhancon point, but rather the gauge group remains U(1)^{N-1} and light electric and magnetically charged particles coexist. We also study the moduli space metric for a single probe brane in the background of N-1 branes near the enhancon point. We find quantum corrections to the supergravity probe metric that are not suppressed at large separations, but are down by 1/N factors, due to the response of the N-1 enhancon branes to the probe. A singularity appears before the probe reaches the enhancon point where a dyon becomes massless. We compute the masses of W-bosons and monopoles in a large N limit near this critical point.Comment: 20 pages, 2 figure

Squashed Giants: Bound States of Giant Gravitons

We consider giant gravitons in the maximally supersymmetric type IIB plane-wave, in the presence of a constant NSNS B-field background. We show that in response to the background B-field the giant graviton would take the shape of a deformed three-sphere, the size and shape of which depend on the B-field, and that the giant becomes classically unstable once the B-field is larger than a critical value B_{cr}. In particular, for the B-field which is (anti-)self-dual under the SO(4) isometry of the original giant S^3, the closed string metric is that of a round S^3, while the open string metric is a squashed three-sphere. The squashed giant can be interpreted as a bound state of a spherical three-brane and circular D-strings. We work out the spectrum of geometric fluctuations of the squashed giant and study its stability. We also comment on the gauge theory which lives on the brane (which is generically a noncommutative theory) and a possible dual gauge theory description of the deformed giant.Comment: Latex file, 32 pages, 6 .eps figures; v3: typos correcte

A toy model for the AdS/CFT correspondence

We study the large N gauged quantum mechanics for a single Hermitian matrix in the Harmonic oscillator potential well as a toy model for the AdS/CFT correspondence. We argue that the dual geometry should be a string in two dimensions with a curvature of stringy size. Even though the dual geometry is not weakly curved, one can still gain knowledge of the system from a detailed study of the open-closed string duality. We give a mapping between the basis of states made of traces (closed strings) and the eigenvalues of the matrix (D-brane picture) in terms of Schur polynomials. We connect this model with the study of giant gravitons in AdS_5 x S^5. We show that the two giant gravitons that expand along AdS_5 and S^5 can be interpreted in the matrix model as taking an eigenvalue from the Fermi sea and exciting it very much, or as making a hole in the Fermi sea respectively. This is similar to recent studies of the c=1 string. This connection gives new insight on how to perform calculations for giant gravitons.Comment: 19 pages JHEP, 4 figures. v2: comments added, typos fixed, additional refs. v3: The paper has been largely revised, to make the relation as a limit of N=4 SYM clear, also some proofs have been written in full rather than sketched. This updated version reflects the changes that were made in the published versio

Assessing bowel preparation quality using the mean number of adenomas per colonoscopy

Introduction: The quality of the bowel preparation directly influences colonoscopy effectiveness. Quality indicators are widely employed to monitor operator performance and to gauge colonoscopy effectiveness. Some have suggested that the enumeration of the mean number of adenomas per colonoscopy (MNA) may be a more useful measure of bowel preparation quality, but evidence of the utility of this metric is limited. The relationship between bowel preparation quality and MNA was assessed. Methods: Records of adult patients, aged 50–74 years, who had undergone a screening colonoscopy in a 6 month period at a hospital-based endoscopy suite in New York City were examined. Excluded were those who were symptomatic or having a colonoscopy for surveillance. Patient and procedural characteristics and clinical findings were abstracted from the endoscopy database. Bowel preparation quality was recorded as excellent, good, fair and poor. Histology and size of polyps removed were gathered from pathology reports. MNA was calculated and incident rate ratios assessing the relationship between bowel preparation quality, MNA, and covariates was calculated using Poisson regression. Results: A total of 2422 colonoscopies were identified; 815 (33.6%) were screening colonoscopies among average risk individuals, 50–74 years; 203 (24.9%) had ≥1 adenomas; and 666 (81.7%) had excellent/good preparation quality. Overall MNA was 0.34 [standard deviation (SD) 0.68] and MNA was greater among those >60 years [incident rate ratio (IRR) 1.89, 95% confidence interval (CI) 1.48–2.42), males (IRR 1.60, 95%CI 1.26–2.04) and those with good bowel preparation (IRR 2.54, 95%CI 1.04–6.16). Among those with ≥1 adenomas, MNA was 1.48 (SD 1.05) for excellent and 1.00 (SD 0.00) for poor quality preparation (p = 0.55). Conclusions: We found that MNA is sensitive to changes in bowel preparation with higher MNA among those with good bowel preparation compared with those with poor preparation. Our evidence suggests MNA was particularly sensitive when restricted to only those in whom adenomas were seen