Editorial: you bet your life – medication risk taking by gastroparesis patients in a hypothetical exercise

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/148392/1/apt15166.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/148392/2/apt15166_am.pd

Investigation of amplidyne position and rate-controlled power drives

This thesis document was issued under the authority of another institution, not NPS. At the time it was written, a copy was added to the NPS Library collection for reasons not now known. It has been included in the digital archive for its historical value to NPS. Not believed to be a CIVINS (Civilian Institutions) title.http://www.archive.org/details/investigationofa00haslU.S. Navy (U.S.N.) authors

Response to the letter by Udo Bonnet

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153273/1/nmo13715_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153273/2/nmo13715.pd

Data Validation of the NASA Time-Resolved Observations of Precipitation Structure and Storm Intensity with a Constellation of Smallsats (TROPICS) Pathfinder Microwave Radiometer

Launched in June 2021, the TROPICS Pathfinder CubeSat has a microwave radiometer payload sensitive to the frequencies for observing precipitation, humidity, temperature, and cloud ice. The observed brightness temperatures must be compared to a data set of ‘known’ quality to validate the measured data across all channels of the microwave radiometer. This research explores validating TROPICS Pathfinder data against reanalysis data to determine the quality of the provisional TROPICS Pathfinder data product, with an eye for the future of comparing against other microwave radiometer measurements. Validation involves comparing Pathfinder data to ERA5 reanalysis data by using the Community Radiative Transfer Model (CRTM) to calculate simulated radiances. The simulated radiances are then compared to the on-orbit Pathfinder data to determine biases, in a method known as single-differencing. The Pathfinder data presented here is at the provisional data maturity level and should be considered preliminary. This effort will be repeated when the TROPICS Pathfinder Level-1 radiances reach the validated data product maturity level late in the summer of 2022. To effectively validate the Pathfinder mission, we have developed a process using MATLAB to read and match the TROPICS Pathfinder data for latitudes between -40° – 40° with desired data for comparison, which is ERA5 in this research. These latitude-longitude data match-ups are then filtered for data points without clouds, using cloud cover data from the GOES-16 satellite. Using data that is cloud-free and overocean ensures that single-differencing comparisons are made using like-data sets and will result in minimal error introduced by the reanalysis and radiative transfer models. After filtering the data, this validation process generates the input files required by CRTM to simulate the model, simulates these observations using the unique Pathfinder CRTM coefficients resulting in the most accurate data, and performs the necessary difference calculations. The end result is an automated process that performs data comparisons for researchers, and we present them as a summary for analysis. The provisional Level-1 radiances show good agreement with combined ERA5 and CRTM simulated radiances, and we expect even better agreement with the upcoming validated Level-1 radiances

Impact of gastric per‐oral endoscopic myotomy on static and dynamic pyloric function in gastroparesis patients

BackgroundFunctional Lumen Imaging Probe (EndoFLIP) tests typically measure static pyloric parameters, but the pylorus exhibits phasic variations on manometry. Dynamic changes in pyloric function have not been quantified using EndoFLIP, and the impact of Gastric Per‐Oral Endoscopic Myotomy (G‐POEM) on static and dynamic pyloric activity in gastroparesis is unknown.MethodsEndoFLIP balloon inflation to 30, 40, and 50 mL was performed to measure mean, maximum, and minimum values and variability in pyloric diameter and distensibility before and after G‐POEM in 20 patients with refractory gastroparesis. The impact of phasic contractions on these pyloric measures was compared.Key ResultsG‐POEM increased mean (P < .0001) and maximum (P = .0002) pyloric diameters and mean (P = .02) and maximum (P = .02) pyloric distensibility on 50 mL EndoFLIP inflation but not intraballoon pressures or minimum diameters or distensibility. Temporal variability of pyloric diameter (P = .02) and distensibility (P = .02) also increased after G‐POEM. Phasic coupled contractions propagating from the antrum through the pylorus were observed in 37.5% of recordings; other phasic activity including isolated pyloric contractions were seen in 23.3%. Variability of pyloric diameter and distensibility tended to be higher during recordings with phasic activity. Some pyloric responses to G‐POEM were influenced by age, gastroparesis etiology, gastric emptying, and prior botulinum toxin injection.Conclusions & InferencesPyloric activity exhibits dynamic changes on EndoFLIP testing in gastroparesis. G‐POEM increases maximal but not minimal diameter and distensibility with increased variations, suggesting this therapy enhances pyloric opening but may not impair pyloric closure. Phasic pyloric contractions contribute to variations in pyloric activity.We employed Functional Lumen Imaging Probe (EndoFLIP)tests toshowincreases in pyloric diameter and variability of diameter after gastricperoralendoscopicmyotomy(G‐POEM ingastroparesis patients (left graphs). Variability of pyloric activity was noted before and after G‐POEM which was partly due to propagated antropyloriccontractions (3‐D plot on right) detected by EndoFLIP.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163489/2/nmo13892_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163489/1/nmo13892.pd

Evaluation of gastrointestinal transit in clinical practice: position paper of the American and European Neurogastroenterology and Motility Societies

Disorders of gastrointestinal (GI) transit and motility are common, and cause either delayed or accelerated transit through the stomach, small intestine or colon, and affect one or more regions. Assessment of regional and/or whole gut transit times can provide direct measurements and diagnostic information to explain the cause of symptoms, and plan therapy.Recently, several newer diagnostic tools have become available. The American and European Neurogastroenterology and Motility Societies undertook this review to provide guidelines on the indications and optimal methods for the use of transit measurements in clinical practice. This was based on evidence of validation including performance characteristics, clinical significance, and strengths of various techniques. The tests include measurements of: gastric emptying with scintigraphy, wireless motility capsule, and 13 C breath tests; small bowel transit with breath tests, scintigraphy, and wireless motility capsule; and colonic transit with radioopaque markers, wireless motility capsule, and scintigraphy. Based on the evidence, consensus recommendations are provided for each technique and for the evaluations of regional and whole gut transit. In summary, tests of gastrointestinal transit are available and useful in the evaluation of patients with symptoms suggestive of gastrointestinal dysmotility, since they can provide objective diagnosis and a rational approach to patient management.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79321/1/j.1365-2982.2010.01612.x.pd

On-Orbit Results From the NASA Time-Resolved Observations of Precipitation Structure and Storm Intensity With a Constellation of Smallsats (TROPICS) Mission

The NASA TROPICS Earth Venture (EVI-3) CubeSat constellation mission will provide nearly all-weather observations of 3-D temperature and humidity, as well as cloud ice and precipitation horizontal structure, at high temporal resolution to conduct high-value science investigations of tropical cyclones. TROPICS will provide rapid-refresh microwave measurements (median refresh rate better than 60 minutes for the baseline mission) over the tropics that can be used to observe the thermodynamics of the troposphere and precipitation structure for storm systems at the mesoscale and synoptic scale over the entire storm lifecycle. The TROPICS constellation mission comprises four 3UCubeSats (5.4 kg each) in two low-Earth orbital planes. Each CubeSat contains a Blue Canyon Technologies bus and a high-performance radiometer payload to provide temperature profiles using seven channels near the 118.75 GHz oxygen absorption line, water vapor profiles using three channels near the 183 GHz water vapor absorption line, imagery in a single channel near 90 GHz for precipitation measurements (when combined with higher resolution water vapor channels), and a single channel at 205 GHz that is more sensitive to precipitation-sized ice particles. TROPICS spatial resolution and measurement sensitivity is comparable with current state-of-the-art observing platforms. Two dedicated launches (two spacecraft per launch) for the TROPICS constellation mission on Rocket Lab Electron vehicles occurred in 2023 (May 8 and May 26) to place the spacecraft in 32.75-degree inclined orbits at 550 km altitude. Data will be downlinked to the ground via the KSAT-Lite ground network. NASA\u27s Earth System Science Pathfinder (ESSP) Program Office approved the separate TROPICS Pathfinder mission, which launched on June 30, 2021, in advance of the TROPICS constellation mission as a technology demonstration and risk reduction effort. The TROPICS Pathfinder mission has provided an opportunity to checkout and optimize all mission elements prior to the primary constellation mission and is still operating nominally

Cyclic vomiting syndrome: Pathophysiology, comorbidities, and future research directions

Cyclic vomiting syndrome (CVS) is characterized by severe episodic emesis in adults and children. Cannabinoid hyperemesis syndrome is an increasingly recognized CVS‐like illness that has been associated with chronic cannabis use. There are significant gaps in our understanding of the pathophysiology, clinical features, comorbidities, and effective management options of CVS. Recommendations for treating CVS are based on limited clinical data, as no placebo‐controlled, randomized trials have yet been conducted. Diseases associated with CVS, including migraine, mitochondrial disorders, autonomic dysfunction, and psychiatric comorbidities, provide clues about pathophysiologic mechanisms and suggest potential therapies. We review our current understanding of CVS and propose future research directions with the aim of developing effective therapy. Establishing a multicenter, standardized registry of CVS patients could drive research on multiple fronts including developing CVS‐specific outcome measures to broaden our understanding of clinical profiles, to serve as treatment end points in clinical trials, and to provide a platform for patient recruitment for randomized clinical trials. Such a robust database would also facilitate conduct of research that aims to determine the underlying pathophysiological mechanisms and genetic basis for CVS, as well as identifying potential biomarkers for the disorder. Soliciting government and industry support is crucial to establishing the necessary infrastructure and achieving these goals. Patient advocacy groups such as the Cyclic Vomiting Syndrome Association (CVSA), which partner with clinicians and researchers to disseminate new information, to promote ongoing interactions between patients, their families, clinicians, investigators, to support ongoing CVS research and education, must be an integral part of this endeavor.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149751/1/nmo13607.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149751/2/nmo13607_am.pd

Autonomic function in gastroparesis and chronic unexplained nausea and vomiting: Relationship with etiology, gastric emptying, and symptom severity

BackgroundAutonomic dysfunction can be present in patients with idiopathic and diabetic gastroparesis. The role of autonomic dysfunction relating to gastric emptying and upper gastrointestinal symptoms in patients with gastroparesis and chronic unexplained nausea and vomiting (CUNV) remains unclear. The aim of our study is to evaluate autonomic function in patients with gastroparesis and CUNV with respect to etiology, gastric emptying and symptom severity.MethodsWe studied 242 patients with chronic gastroparetic symptoms recruited at eight centers. All patients had a gastric emptying scintigraphy within 6 months of the study. Symptom severity was assessed using the gastroparesis cardinal symptom index. Autonomic function testing was performed at baseline enrollment using the ANX 3.0 autonomic monitoring system which measures heart rate variability and respiratory activity measurements.Key ResultsLow sympathetic response to challenge (Valsalva or standing) was the most common abnormality seen impacting 89% diabetic and 74% idiopathic patients. Diabetics compared to idiopathics, exhibited greater global hypofunction with sympathetic (OR = 4.7, 95% CI 2.2‐10.3; P < .001) and parasympathetic (OR = 7.2, 95% CI 3.4‐15.0; P < .001) dysfunction. Patients with delayed gastric emptying were more likely to have paradoxic parasympathetic excessive during sympathetic challenge [(Valsalva or standing) 40% vs. 26%, P = .05]. Patients with more severe symptoms exhibited greater parasympathetic dysfunction compared to those with mild‐moderate symptoms: resting sympathovagal balance [LFa/RFa 1.8 (1.0‐3.1) vs. 1.2 (0.6‐2.3), P = .006)] and standing parasympathetic activity [0.4 (0.1‐0.8) vs. 0.6 (0.2‐1.7); P = .03].ConclusionsAutonomic dysfunction was common in patients with gastroparesis and CUNV. Parasympathetic dysfunction was associated with delayed gastric emptying and more severe upper gastrointestinal symptoms. Conversely, sympathetic hypofunction was associated with milder symptoms.InferencesGastroparesis and CUNV may be a manifestation of GI autonomic dysfunction or imbalance, such that sympathetic dysfunction occurs early on in the manifestation of chronic upper GI symptoms, while parasympathetic dysfunction results in more severe symptoms and delayed gastric emptying.Sympathetic withdrawal (low sympathetic activity in response to a sympathetic challenge) was the most common autonomic abnormality found among all patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156243/2/nmo13810_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156243/1/nmo13810.pd