The Ballpark podcast episode 2.6: racism towards Latinos: past, present, and future

The current US president is not the first American leader to use inflammatory rhetoric about Latinos and push anti-immigration policies, but Donald Trump's presidency has certainly brought these issue to the forefront of American politics. This episode we're diving into the fear, resentment, and history behind racism towards Latinos, and in doing so, we'll see that this is far from ..

Computerized 3-dimensional Localization of a Video Capsule in the Abdominal Cavity: Validation by Digital Radiography

Background: Video capsule endoscopy has become the gold standard for examining the small bowel and defining pathological lesions, however, localization of a specific lesion remains largely guesswork. We report the validation of a new 3D localization software using radiological localization in volunteers. Methods: 30 volunteers with no known prior history of gastrointestinal disease swallowed the EC-10 video capsule. A sensor array with six radiopaque markers was placed on the anterior abdominal wall. Once the capsule was visualized to be in the small intestine using a real time viewer, five sets of low dose x-rays were taken every thirty minutes. Distances between sensor points and the capsule were measured on the x-rays to provide X, Y, and Z coordinates and compared with the distances calculated by the software from the same points. Results: Data from 27 of the 30 subjects were suitable for analysis. There were three technical failures. Our study evaluated the accuracy of the “Capsule 3D Track function” which calculated the capsule position based on the signal strength received at the sensor array. The accuracy of the position was compared to the actual position of the capsule as determined by radiographic images obtained during the capsule’s transit through the small bowel. The average error for the software measurement for each of the three coordinates was: X -2.00 cm (SD 1.64 cm), Y -- 2.64 cm (SD 2.39 cm), and Z --2.51 cm (1.83 cm). Conclusion: The localization error reported here is comparable to the existing system for localization, however, it provides localization across all three spatial dimensions which has never been achieved before. The potential utility of this technology is yet to be seen, however, as it needs to now be studied in a prospective clinical trial for patients with suspected small bowel pathology

Reduced fetal growth velocity and weight loss are associated with adverse perinatal outcome in fetuses at risk of growth restriction.

BACKGROUND Although fetal size is associated with adverse perinatal outcome, the relationship between fetal growth velocity and adverse perinatal outcome is unclear. OBJECTIVE This study aimed to evaluate the relationship between fetal growth velocity and signs of cerebral blood flow redistribution, and their association with birthweight and adverse perinatal outcome. STUDY DESIGN This study was a secondary analysis of the TRUFFLE-2 multicenter observational prospective feasibility study of fetuses at risk of fetal growth restriction between 32+0 and 36+6 weeks of gestation (n=856), evaluated by ultrasound biometry and umbilical and middle cerebral artery Doppler. Individual fetal growth velocity was calculated from the difference of birthweight and estimated fetal weight at 3, 2, and 1 week before delivery, and by linear regression of all available estimated fetal weight measurements. Fetal estimated weight and birthweight were expressed as absolute value and as multiple of the median for statistical calculation. The coefficients of the individual linear regression of estimated fetal weight measurements (growth velocity; g/wk) were plotted against the last umbilical-cerebral ratio with subclassification for perinatal outcome. The association of these measurements with adverse perinatal outcome was assessed. The adverse perinatal outcome was a composite of abnormal condition at birth or major neonatal morbidity. RESULTS Adverse perinatal outcome was more frequent among fetuses whose antenatal growth was <100 g/wk, irrespective of signs of cerebral blood flow redistribution. Infants with birthweight <0.65 multiple of the median were enrolled earlier, had the lowest fetal growth velocity, higher umbilical-cerebral ratio, and were more likely to have adverse perinatal outcome. A decreasing fetal growth velocity was observed in 163 (19%) women in whom the estimated fetal weight multiple of the median regression coefficient was <-0.025, and who had higher umbilical-cerebral ratio values and more frequent adverse perinatal outcome; 67 (41%; 8% of total group) of these women had negative growth velocity. Estimated fetal weight and umbilical-cerebral ratio at admission and fetal growth velocity combined by logistic regression had a higher association with adverse perinatal outcome than any of those parameters separately (relative risk, 3.3; 95% confidence interval, 2.3-4.8). CONCLUSION In fetuses at risk of late preterm fetal growth restriction, reduced growth velocity is associated with an increased risk of adverse perinatal outcome, irrespective of signs of cerebral blood flow redistribution. Some fetuses showed negative growth velocity, suggesting catabolic metabolism

Development and Validation of a Clinical Scoring System to Differentiate Patients with Inflammatory Bowel Disease and Diarrhea-Predominant Irritable Bowel Disease

Background: There is no validated scoring system for differentiating inflammatory bowel disease (IBD) from irritable bowel syndrome (IBS). Studies variably report clinical measures such as radiology, endoscopy, inflammatory markers, and symptoms to separate IBS from IBD. Our study seeks to create a system to IBD patients from IBS. The “REBISS” score incorporates various clinical criteria used commonly for diagnosis. We also studied a second system called “REBISS-PCP” focusing on a subset of criteria that are available to PCPs when faced with this challenge. Methods: This study was approved by the UMass IRB. Two cohorts were identified: 24 IBD patients (Group1) and 24 IBS patients (Group2). Subjects in Group1 were patients with Crohn’s or ulcerative colitis. Subjects in Group2 were identified as having IBS based on ROME III criteria. Retrospective analysis was performed and a score was calculated. One point is assigned for having: radiological findings consistent with IBD, endoscopic findings of inflammation or ulceration, biopsy findings consistent with IBD, elevated inflammatory markers, weight loss, hematochezia, extra-intestinal signs/symptoms, palpable mass on exam, and perianal disease. The maximum score is 10 points. For the REBISS-PCP score, the same clinical criteria were studied with the exclusion of endoscopic and biopsy findings. Maximum score for that system is 8 points. A likelihood ratio chi-square test was performed for both cohorts and scoring systems. Results: The REBISS scoring system showed a significant differentiation of the two cohorts in regards to scoring distribution (chi-square value = 59.8; p\u3c0.0001). The REBISS-PCP scoring system also found a significant differentiation of the two cohorts (chi-square value = 35.7;p\u3c 0.0001). Discussion: The REBISS scoring system could be used to standardize IBD and IBSd populations in an academic research setting, while both the REBISS and REBISS-PCP scoring system could be used as a screening tool in clinical practice

A Reconsideration of the Diagnosis and Management of Gastrointestinal Bleeding Based on its Epidemiology and Outcomes Analysis

Background: Traditionally, gastrointestinal bleeding (GIB) has been divided into upper and lower GIB with little consideration of the small bowel as a source. Furthermore, melena is generally included in the upper category, despite its poor localization value. We analyzed 341 consecutive GIB patients to see if those presenting with melena/hematocheiza have less efficient evaluations then when compared to those presenting with hematemesis. Methods: A retrospective analysis was performed for 341 consecutive patients admitted to our ED with GIB over a year. Cohorts were separated based on presenting symptom to the ED, hematemesis (G1) and non-hematemesis (G2). Data obtained included demographics, diagnosis, number and type of procedure, diagnostic yield of each procedure, hours to diagnosis, ICU days, and total hospital days. Results: G1 (n=105, 62%M) was younger than G2 (n=231, 53%M) with a mean age of 54 vs. 66, p≤0.001. 78% and 98% of patients were admitted to the hospital in G1 and G2 respectively (p=0.02). Median time to diagnosis was 14.0 hours and 20.0 hours for G1 and G2 respectively (p≤0.001). Median number of days in the ICU was 3.0 in both groups, and median number of hospital days was 3.0 for G1 vs. 4.0 for G2 (p=0.267). In G1, the 1st procedure was diagnostic 69% of the time vs 54% for G2 (p=0.07). The overall diagnostic yield for EGDs in G1 was 58% vs. 51% in G2 (p=0.279). Colonoscopies overall were diagnostic 39% of the time in G2 and, interestingly, VCEs were the most diagnostic, yielding a diagnosis 74% of the time in G2 (n= 34). Unexpectedly, those admitted in G1 had a confirmed diagnosis only 61% of the time compared to 62% in G2. Conclusion: Our data suggests that a portion of patients presenting with non-hematemesis (G2) are inefficiently managed and a search for an alternative strategy is warranted. Early deployment of VCE may be a more efficient and economic option, although prospective evaluation of this concept is needed

A Year of Gastrointestinal Bleeding: An Epidemiologic Study

Background: For decades the diagnosis and management of gastrointestinal bleeding (GIB) has been based largely on endoscopy. Studying a large cohort of patients presenting to the ED we may find cost-effective alternatives in the management of GIB. We analyzed the epidemiology and initial disposition of all patients who presented to our ED from the perspective of hematemesis versus non-hematemesis, to identify patterns among each cohort’s presentations to aid in this. Methods: Retrospective analysis of medical records for 338 patients presenting to the UMass ED. Two cohorts were identified: those with hematemesis (G1) or non-hematemesis (G2). Results: 105 patients presented to the ED with hematemesis (G1), 233 patients presented with non-hematemesis GIB (G2). G1 was younger than G2 (54.4 years vs. 65.6 years, p\u3c0.001). There were more males in G1 vs. G2 (61% vs. 53%, p=0.154). Comorbities in G1 were liver disease (21%), alcohol abuse (20%), and diabetes (11%). Comorbities in G2 were coronary artery disease (22%), atrial fibrillation (13.7%), and diverticulosis (8%). More patients in G2 than G1 used Coumadin (23% vs. 7%, p\u3c0.001), anti-platelet agents (12% and 3%, p\u3c0.004), and NSAIDs (40% and 32%y, p=0.203). Admission hematocrit was greater in G1 compared to G2 (34.1 vs. 30.0, p\u3c0.001). INR was greater in G2 compared to G1 (1.7 vs. 1.3, p=0.03). BUN was greater in G2 compared to G1 (30.2 vs. 23.6, p=0.021). More patients in G2 were admitted compared to G1 (89.6% vs. 78.1%, p=0.019). More were admitted to the ICU in G1 compared to G2 (46% vs. 38%, p=0.237).Discussion: This study uses a novel approach that elicits different patterns than the traditional delineation of upper versus lower GIB. These results may lead to new decision-making in patients presenting with GIB, allowing for new diagnostic and management paradigms, resulting in cost-effective care

The Absolute Magnitudes of Type Ia Supernovae in the Ultraviolet

We examine the absolute magnitudes and light-curve shapes of 14 nearby(redshift z = 0.004--0.027) Type Ia supernovae (SNe~Ia) observed in the ultraviolet (UV) with the Swift Ultraviolet/Optical Telescope. Colors and absolute magnitudes are calculated using both a standard Milky Way (MW) extinction law and one for the Large Magellanic Cloud that has been modified by circumstellar scattering. We find very different behavior in the near-UV filters (uvw1_rc covering ~2600-3300 A after removing optical light, and u ~3000--4000 A) compared to a mid-UV filter (uvm2 ~2000-2400 A). The uvw1_rc-b colors show a scatter of ~0.3 mag while uvm2-b scatters by nearly 0.9 mag. Similarly, while the scatter in colors between neighboring filters is small in the optical and somewhat larger in the near-UV, the large scatter in the uvm2-uvw1 colors implies significantly larger spectral variability below 2600 A. We find that in the near-UV the absolute magnitudes at peak brightness of normal SNe Ia in our sample are correlated with the optical decay rate with a scatter of 0.4 mag, comparable to that found for the optical in our sample. However, in the mid-UV the scatter is larger, ~1 mag, possibly indicating differences in metallicity. We find no strong correlation between either the UV light-curve shapes or the UV colors and the UV absolute magnitudes. With larger samples, the UV luminosity might be useful as an additional constraint to help determine distance, extinction, and metallicity in order to improve the utility of SNe Ia as standardized candles.Comment: 59 pages, accepted for publication in Ap