Data Curation and Application of Statewide Data on Involuntary Assessment and Treatment in Behavioral Health

Our university, based data center has curated statewide data on short-term, involuntary examinations for mental illness/co-occurring disorders for over two decades. We recently began receiving petitions and orders for longer-term civil commitment from Clerks of Court. We are currently developing a system to curate data on involuntary assessments/treatment for substance use disorders. The involuntary examination data have been used to produce 100+ ad hoc reports for a variety of stakeholders, a statutorily required annual report, as well as to inform the state legislature, advocates, agencies, and several statewide taskforces relating to criminal justice and mental health initiatives. Data from documents are currently received and entered in a) hard copy via the mail, b) securely scanned and transferred either via SFTP or with secure transfer to our University’s Box.com account, or c) direct provider entry into a secure web portal. Our University’s IT environment has evolved, with an escalation of organizational and policy changes related to the merging of two IT units. While this merging has led to innovation, it has also presented operational, organizational and logistical challenges. Discussed in this presentation will be a) these IT challenges, b) the pros and cons of form submission methods, c) how choice of submission method is informed by the capabilities of those submitting the documents in addition to, the resources and capabilities of our center within the context of current funding, as well as d) how this impacts choices made about data entry, data quality and use of the data for analyses

Survival Benefit for Individuals With Constitutional Mismatch Repair Deficiency Undergoing Surveillance

PURPOSE: Constitutional mismatch repair deficiency syndrome (CMMRD) is a lethal cancer predisposition syndrome characterized by early-onset synchronous and metachronous multiorgan tumors. We designed a surveillance protocol for early tumor detection in these individuals. PATIENTS AND METHODS: Data were collected from patients with confirmed CMMRD who were registered in the International Replication Repair Deficiency Consortium. Tumor spectrum, efficacy of the surveillance protocol, and malignant transformation of low-grade lesions were examined for the entire cohort. Survival outcomes were analyzed for patients followed prospectively from the time of surveillance implementation. RESULTS: A total of 193 malignant tumors in 110 patients were identified. Median age of first cancer diagnosis was 9.2 years (range: 1.7-39.5 years). For patients undergoing surveillance, all GI and other solid tumors, and 75% of brain cancers were detected asymptomatically. By contrast, only 16% of hematologic malignancies were detected asymptomatically (P \u3c .001). Eighty-nine patients were followed prospectively and used for survival analysis. Five-year overall survival (OS) was 90% (95% CI, 78.6 to 100) and 50% (95% CI, 39.2 to 63.7) when cancer was detected asymptomatically and symptomatically, respectively (P = .001). Patient outcome measured by adherence to the surveillance protocol revealed 4-year OS of 79% (95% CI, 54.8 to 90.9) for patients undergoing full surveillance, 55% (95% CI, 28.5 to 74.5) for partial surveillance, and 15% (95% CI, 5.2 to 28.8) for those not under surveillance (P \u3c .0001). Of the 64 low-grade tumors detected, the cumulative likelihood of transformation from low-to high-grade was 81% for GI cancers within 8 years and 100% for gliomas in 6 years. CONCLUSION: Surveillance and early cancer detection are associated with improved OS for individuals with CMMRD

Investigation of two Fermi-LAT gamma-ray blazars coincident with high-energy neutrinos detected by IceCube

After the identification of the gamma-ray blazar TXS 0506+056 as the first compelling IceCube neutrino source candidate, we perform a systematic analysis of all high-energy neutrino events satisfying the IceCube realtime trigger criteria. We find one additional known gamma-ray source, the blazar GB6 J1040+0617, in spatial coincidence with a neutrino in this sample. The chance probability of this coincidence is 30% after trial correction. For the first time, we present a systematic study of the gamma-ray flux, spectral and optical variability, and multi-wavelength behavior of GB6 J1040+0617 and compare it to TXS 0506+056. We find that TXS 0506+056 shows strong flux variability in the Fermi-LAT gamma-ray band, being in an active state around the arrival of IceCube-170922A, but in a low state during the archival IceCube neutrino flare in 2014/15. In both cases the spectral shape is statistically compatible ($\leq 2\sigma$) with the average spectrum showing no indication of a significant relative increase of a high-energy component. While the association of GB6 J1040+0617 with the neutrino is consistent with background expectations, the source appears to be a plausible neutrino source candidate based on its energetics and multi-wavelength features, namely a bright optical flare and modestly increased gamma-ray activity. Finding one or two neutrinos originating from gamma-ray blazars in the given sample of high-energy neutrinos is consistent with previously derived limits of neutrino emission from gamma-ray blazars, indicating the sources of the majority of cosmic high-energy neutrinos remain unknown.Comment: 22 pages, 11 figures, 2 Table

Broadband Multi-wavelength Properties of M87 during the 2017 Event Horizon Telescope Campaign

Abstract: In 2017, the Event Horizon Telescope (EHT) Collaboration succeeded in capturing the first direct image of the center of the M87 galaxy. The asymmetric ring morphology and size are consistent with theoretical expectations for a weakly accreting supermassive black hole of mass ∼6.5 × 109 M ⊙. The EHTC also partnered with several international facilities in space and on the ground, to arrange an extensive, quasi-simultaneous multi-wavelength campaign. This Letter presents the results and analysis of this campaign, as well as the multi-wavelength data as a legacy data repository. We captured M87 in a historically low state, and the core flux dominates over HST-1 at high energies, making it possible to combine core flux constraints with the more spatially precise very long baseline interferometry data. We present the most complete simultaneous multi-wavelength spectrum of the active nucleus to date, and discuss the complexity and caveats of combining data from different spatial scales into one broadband spectrum. We apply two heuristic, isotropic leptonic single-zone models to provide insight into the basic source properties, but conclude that a structured jet is necessary to explain M87’s spectrum. We can exclude that the simultaneous γ-ray emission is produced via inverse Compton emission in the same region producing the EHT mm-band emission, and further conclude that the γ-rays can only be produced in the inner jets (inward of HST-1) if there are strongly particle-dominated regions. Direct synchrotron emission from accelerated protons and secondaries cannot yet be excluded

Assessing Parental Attitudes Towards Hepatoblatosma Screening

OBJECTIVES: Familial adenomatous polyposis (FAP) is an autosomal dominant cancer predisposition syndrome with nearly a 100% lifetime risk of developing colorectal cancer, if left untreated. Children with FAP have up to a 2% risk for the development of hepatoblastoma (HB). Guidelines for HB screening are not well established, as screening for HB is controversial. The objectives of this study were to assess parental awareness of HB risk, as well as parental attitudes and beliefs regarding clinical utilization of HB screening. METHODS: Forty-six parents of thirty-eight households with children under the age of 18, or with HB diagnosis at any age, completed a 62-item survey on personal and family clinical information related to FAP, demographics, as well as attitudes towards genetic testing, and the use HB screening. RESULTS: Thirty-one affected parents, and fifteen unaffected parents participated. Parental perceptions of benefits and barriers of HB screening showed statistically significant associations with parental decision to use HB screening. Thirty-two parents (70%) would use HB screening for their children. Doctor recommendation and informative genetic test result were the most influential factors. Exactly 50% of parents were aware of the risk for HB. Eleven households (29%) reported clinical use of HB screening. Nearly 74% of individuals who were unaware of HB risk, and 64% of individuals who had not received recommendations for HB screening indicated that they would utilize HB screening. CONCLUSIONS: Parents are interested in clinical utilization of HB screening. Health care providers of families with FAP should discuss the availability of HB screening in children with or without the precedence of genetic testing

Statistical properties of flux variations in blazar light curves at GeV and TeV energies

Despite numerous detections of individual flares, the physical origin of the rapid variability observed from blazars remains uncertain. Using Bayesian blocks and the Eisenstein-Hut HOP algorithm, we characterize flux variations of high significance in the γ-ray light curves of two samples of blazars. Daily binned long-term light curves of TeV-bright blazars observed with the First G-APD Cherenkov Telescope (FACT) are compared to those of GeV-bright blazars observed with the Large Area Telescope on board the Fermi Gamma-ray Space Telescope (Fermi-LAT). We find no evidence for systematic asymmetry of the flux variations based on the derived rise and decay time scales. Additionally, we show that the daily-binned blazar light curves can be described by an exponential stochastic Ornstein-Uhlenbeck process with parameters depending on energy. Our analysis suggests that the flux variability in both samples is a superposition of faster fluctuations. This is, for instance, challenging to explain by shock-acceleration but expected for magnetic reconnection.ISSN:1824-803